Going global

Medical clinics prepare travelers for unexpected hazards

Before H1N1, there was avian flu. Before avian flu, there was SARS, or severe acute respiratory syndrome.

In an increasingly connected world with people traveling for business and for pleasure, health is a global concern both for individuals and communities. Travel medicine, which focuses on keeping individuals healthy while they’re on the move, also keeps communities safe from pathogens that can be carried back from exotic locales.

Dr. Tasleyma Sattar, medical director of the Travel Medicine Clinic in the UNT Health Science Center’s Advanced Medical Clinic, took charge of the three-year-old clinic in September 2009. One of her primary goals is to raise awareness for the need for travel medicine.

“Most primary care physicians are not trained for these intricacies of travel medicine. They may know because of their own individual experience, but generally they’re not trained,” Sattar said.

Sattar, herself an assistant professor in the family medicine department at the Health Science Center, said her clinic focuses not only on preventing diseases with vaccines, prescriptions and education, but also on managing diseases a patient may already have.

A traveler with chronic obstructive pulmonary disease, for example, may be affected by being at elevation since there is less oxygen in the air. There is a prescription that can help these patients better cope with the altitude, but some foresight is necessary to get the prescription prior to traveling, she said.

Additionally, patients who have diabetes can be affected by dehydration, a common side effect to traveling.

“When you’re in the middle of the safaris, the last thing you’re thinking about is if you’re well hydrated,” Sattar said. “You’re thinking of getting that wonderful photo, of seeing the animals.”

Most of Sattar’s patients come in by appointment, and she gives her e-mail and cell phone number to patients who are heading out of the country. It can be scary for a patient to need medical help in another country, she said, and she can help find appropriate medical care through networks like the International Society of Travel Medicine, based in Decatur, Ga.

“We’re very secure where we are, here. At home, we know there is always medical care available around the corner. In a lot of these countries . . . around the corner could be the worst thing you could do for medical care,” she said.

Each year, the Centers for Disease Control and Prevention publishes the “Yellow Book,” a reference for travelers, and it suggests turning to a U.S. consulate or a directory from the ISTM or other such group to find medical help while abroad. The problem is that it’s not unheard of for travelers to actually contract a disease while receiving medical help, Sattar said.

The Yellow Book, for example, recommends travelers in developing countries only receive blood transfusions in life-and-death situations with no other options since a World Health Organization Global Database on Blood Safety report shows that 40 countries report not testing all donated blood for HIV, hepatitis B and C viruses and syphilis. Also in the report, 39 countries admit to allowing blood into clinical use without testing for transmissible infections because of a lack of testing supplies.

Nancy Coon, nursing supervisor for the Tarrant County Public Health Travel Health Services, coordinates with four county sites that focus on travel medicine.

“You want to prevent everything that you can,” she said. “It’s a lot easier, and better for you. You don’t want to bring things back home to your family, you don’t want to get sick either.”

Sattar said travel medicine isn’t heavily emphasized in medical curriculums, but it’s offered as an elective rotation for medical students at the Texas College of Osteopathic Medicine. Patients can take some initiative by telling their physician about upcoming travel plans or volunteering that they have traveled if they arrive home and don’t feel well. She said more physicians are taking into account travel when treating diseases, though, and will ask patients if they’ve been out of the country.

Coon said many of the patients she sees are referrals from area physicians.

“I think there’s an awareness that there is a need for travel medicine and there is an effort within the travel medicine professionals to make it a more standardized practice,” she said.