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STAYING HEALTHY ON OUTREACH:
What Health-Care Professionals Need to Know page 3 of 3
By Christopher Bajkiewicz RN BSN
O ORAL REHYDRATION - DRINK UP!
Tropical heat alone can quickly dehydrate you and deplete electrolytes. Fever or diarrhea
accelerates the process, debilitating the healthiest person. Without aggressive rehydration,
antibiotics will not work optimally. Delaying oral rehydration can lead to dehydrational
emergencies.
Prevent dehydration by consuming water and electrolyte solutions (commercial sports drinks
when healthy) to provoke every 2- to 4-hour urination. Watch for signs of dehydration in
yourself and fellow outreach team members. Don’t purposely dehydrate yourself to avoid use of
primitive latrines, a common female outreach idea.
If you become ill with vomiting, diarrhea or fever, begin using the Oral Rehydration salts in your
Travel Kit. Consume to restore and maintain urination every 1 to 2 hours. If illness persists,
seek medical attention, taking your IV solutions, tubing and IV needles with you.
If you run out of the commercial Rehydration salts, you can make ‘emergency rehydration drink’:
<> take one glass of drinking water,
<> add one ‘three-finger’ pinch of table salt,
<> taste-test and adjust to insure solution is ONLY ‘as salty as tears’,
<> add one level teaspoon of sugar,
<> add (squeeze in) citrus juice IF AVAILABLE, then
<> consume. Repeat liberally until urinating every 1 to 2 hours. (ref 28, 29).
M MAINTAIN and MONITOR !
Maintaining health on outreach requires planning and wise behaviours in the face of unfamiliar
difficulties and opportunities.
Follow common sense in the daily schedule: a balanced diet, good hygiene, 8 hrs sleep, limit
‘fats, sugars and caffeine’, exercise/walk daily.
Bring sufficient personal care items (tampons, condoms if couple traveling, etc.) Contact lens
users should switch to glasses for the outreach (heat, dust), or at the least bring a spare pair.
Monitor for community-acquired problems. Tuberculosis is endemic in many poor, indigenous
and refugee peoples world-wide (ref 30), and positive outreach health-care worker exposures
have increased in recent years. Portions of Africa are experiencing a resurgence of Polio.
Respiratory problems can be provoked by rampant industrial pollution, indoor smoke from
cooking fires and climate-jumping in the traveler. Exacerbation of asthma can easily result, so
carry rescue inhalers if you have had any problem in the past. Common community disease
problems abound in practice world-wide: conjunctivitis, scabies, lice, impetigo, tinea capitus,
etc. Keep alert for any personal symptoms or changes during the outreach or upon return
home that may have been acquired.
Method of travel may affect your health. Jetlag is commonly reported and has little consensus
on treatment except good hydration and daylight activity. Successful use of hypnotics is not
established (ref 31). Deep Vein Thrombosis (DVT, also now referred to as ‘coach class
syndrome’) can result from long air travel: avoid sitting > 4 hours during any trip, consider
‘upgraded seat’ for trips >8 hours, ask your doctor about the use of preventative aspirin (ref
32). Motion sickness is commonly reported while using regional transportation or over-water
travel; have stand-by meds regardless of history. Back injuries commonly occur by handling
heavy luggage inappropriately. Use good body mechanics, obtain help for heavy items. High
Altitude Pulmonary Edema (HAPE) and general Acute Mountain Sickness has been reported
increasingly in elderly travelers, especially when ascent exceeds 1000 meters/24 hrs. Pre-travel
plan may include stand-by medicines and ability for IMMEDIATE descent of 500m if symptomatic
(ref 33). Hypothermia has posed difficulties at high altitudes, even in summer months.
POST-TRAVEL / RETURN HOME
Many travelers falter in guarding their health when they return home. The ‘stay healthy’
outreach plan has important post-travel aspects:
Malarial chemo-prophylaxis must be completed, usually for 4 FULL weeks after travel is
completed (ref 34).
Complete any vaccine series started pre-travel, insuring complete immunization from any
exposure on the trip, as well as full vaccine (and cost!) benefit for future travel.
Follow-up with all TB/Manntoux testing as planned. Complete other post-travel testing your
physician may have ordered, especially if you have any chronic condition.
Over the next 3 to 6 months, consult with your physician regarding any changes from your pre-
travel ‘norm’: skin (esp. rashes, eruptions, tenderness, lymphatic swelling), persistent diarrhea
or erratic bowel patterns, abdominal pains, fevers, cough, breathing difficulties, weight loss,
headaches, etc... ANYTHING unusual.
HIGH FEVER in a returning traveler is a medical emergency for up to 2 years from travel in a
malarial region, and should be regarded as malaria with immediate medical attention in the
nearest Emergency Department. Insure that all health-caregivers working with you know your
travel history and the potential for malarial infection. (ref 35, 36).
RE-ENTRY
As you re-enter your home environment, establish closure and begin to integrate your outreach
experience into your routine life and practice. Outreach should lead to a deeper compassion
and caring for others. Some return from outreach and find that relatives, friends and
colleagues may not understand the experiences in a foreign land, leading to a sense of
rejection and lack of closure. After working with the poor abroad, most North Americans feel a
sense of guilt and need help processing the experience to find resolution. Re-entry stress can
hamper incorporating the outreach experience into life and professional work, disrupt familiar
relationships and result in a sense of discouragement. Group de-briefing and individual
pastoral care can give context to your outreach experience, as well as help to bring
perspective, closure and a future direction.
Your outreach experience can change your life and bring hope to those with whom you serve.
*****
REFERENCES
1 Stuart R Rose MD, International Travel Health Guide, 12th ed. (Northampton MA, Travel Medicine Inc., 2001):
1-3, 5.
2 David R Hill, “Health Problems in a Large Cohort of Americans Traveling to Developing Countries”, Journal of
Travel Medicine 7, no. 5 (Sept/Oct 2000), 259-67.
3 Ken Gamble MD, “Missionary Health Update 1995”, proceedings of ICCHM/International Conference of
Christian Health Ministries sponsored by MAP International, Brunswick GA
4 U.S. Department of Health and Human Services. Health Information for International Travel, 2001-2002
(‘The Yellow Book’). (Atlanta, GA. Centers for Disease Control, 2001): 181-4.
5 International Society of Travel Medicine, Travel Health Introduction (brochure) 200, ISTM, PO Box 871089,
Stone Mtn, GA 30087. See www.istm.org.
6 Lynne Harper, et.al. “Evaluation of the Coca-Cola Company Travel Health Kit,” Journal of Travel Medicine 9,
no. 5 (Sept/Oct 2002),
244-6.
7 US Dept HHS, IBID, Health Information for International Travel.
8 Charles Rogers and Brian Sytsma, World Vision Safety Manual. (Geneva, 1999): 13-39.
9 Christopher Bajkiewicz, “Drink of Life: Oral Rehydration Therapy”, JCN 16, no 4 (Fall 1999), 9-12.
10 Marge Jones, Psychology of Missionary Adjustment (Logion Press, Springfield MO 1995): 53-5.
11 World Health Organization. International Travel and Health (Geneva, 2002).
12 Centers for Disease Control and Prevention. National Center for Infectious Disease: Travelers Health
(online). Available at www.cdc.gov/travel. (2003)
13 Carmen Hench and Sandra Simpkins. “Travel Medicine”. NurseWeek July 16, 2001. 16-7.
14 Richard Thompson. Travel and Routine Immunizations: A Practical Guide for the Medical Office,
(Shoreland, WI). 1998. Comments of immunizations for Health Care Workers p 162-5.
15 Eva Newman, Going Abroad: A Bathroom Survival Guide. (Marlor Press, St. Paul, 1997).
16 Andreas Schoepke, Robert Steffen and Norman Gratz. “Effectiveness of Personal Protection Measures
against Mosquito Bites for Malaria Prophylaxis in Travelers. J of Travel Medicine 5, no. 4 (Dec 1998), 188-92.
17 Connie Chettle, “West Nile Virus”, NurseWeek, October 21, 2002, 24-5, discussing M Fradin and J Day,
“Comparative efficacy of insect repellants against mosquito bites”, New England Journal of Medicine 347, no 1
(2002) 13-18.
18 Mikio Kimura and Yusuke Wataya. “Inappropriate Use of Mosquito Bed Nets in the Prevention of Malaria:
Lessons from a Familial Cluster of Ovale Malaria”. Journal of Travel Medicine 7, no. 6 (Nov/Dec 2000) 338-9.
19 Hill, IBID, comparing reported case incidence in recent literature.
20 Hans O Lobel and Phyllis Kozarsky. Update on Prevention of Malaria for Travelers. JAMA 278, no. 21 (Dec
2, 1997) 1767-71
21 Tomas Jelinek and Thomas Loscher. “Clinical Features and Epidemiology of Tick Typhus in Travelers”,
Journal of Travel Medicine 8, no. 2 (March/April 2001) 57-9.
22 Paul Arguin, et. al. “Survey of Rabies Preexposure and Postexposure Prophylaxis among Missionary
Personnel Stationed Outside the United States”. Journal of Travel Medicine 7, no. 1 (Jan 2000), 10-14.
23 Erik Krause, Hajo Grundmann and Christoph Hatz. “Pretravel Advice Neglects Rabies Risk for Travelers to
Tropical Countries”. Journal of Travel Medicine 6, no. 3 (September 1999) 163-7.
24 B. Gold et. al. “Current Concepts: Bites of Venomous Snakes”. New England Journal of Medicine 347, no.
5 (Aug 1, 2002), 347-56.
25 Johan Joubert, Andrew C Evans and Chris Schutte. “Schistosomiasis in Africa and International Travel”.
Journal of Travel Medicine 8, no. 2 (Mar/Apr 2001) 92-9.
26 WHO, IBID p56-7, 86.
27 WHO, IBID p 56 notes protocol for “Accidental exposure to blood or other body fluids”. Also see notes at
www.who.int.
28 Bajkiewcz, IBID.
29 William Cutting, “Back to Basics: What is ORT?” Dialouge on Diarrhoea 1, no 52 (March-May 1993): 2-3.
30 Joint United Nations Programme on HIV/AIDS. Refugees and AIDS: UN AIDS Point of View. (United
Nations Publications, New York) 1997.
31 Stuart Rose, IBID p. 55-9. Also see notes at www.tripprep.com/travelinfo
32 Paul Giangrande. Thrombosis and Air Travel. Journal of Travel Medicine 7, no. 3 (May/June 2000), 149-154.
33 Meriam L Dennie and Elizabeth W Bayley. “Into Thinner Air: Preparing for changes in altitude may save your
life.” American Journal of Nursing (suppliment, September 2002). 8-12.
34 Bradley A Connor. “Expert Recommendations for Antimalarial Prophylaxis”. Journal of Travel Medicine 8,
supplement 3 (December 2001), s57-s64.
35 Martin P Grobusch, et. al. “Delayed Primary Attack of Vivax Malaria” (letter), Journal of Travel Medicine 7, no.
2 (March/April 2000) 104-5.
36 World Health Organization, Severe Falciparum Malaria: Transactions of the Royal Society of Tropical
Medicine and Hygiene. (Geneva, 2000). 37-40.
STAYING HEALTHY ON OUTREACH:
What Health-Care Professionals Need to Know
By Christopher Bajkiewicz RN BSN
Copyright © 2003, 2004 by Christopher Bajkiewicz.
All rights reserved. Not for publication or partial use.
This copyrighted work is being made available on the website bajmission.com to help missionary health-care workers in
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