COMMENTARY

CDC Expert Commentary: Staying Healthy on Medical Missions

Phyllis Kozarsky, MD

Disclosures

October 11, 2010

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Hello. This is Dr. Phyllis Kozarsky from the Travelers' Health Branch at CDC and I would like to talk to you about medical missions as part of the CDC Expert Commentary Series on Medscape.

Medical professionals who travel as part of humanitarian missions to provide medical aid often travel unexpectedly, with few medical supplies and limited information. If you are going on one of these trips, you're likely to be more focused on helping others than on your own health and safety. We want to help you anticipate health and safety risks so you can fulfill your mission and avoid illness and injury.

First, you should visit a travel health practitioner. These providers will be most familiar with the risks you're likely to encounter and necessary vaccination schedules. Ideally, this visit should be 4 to 6 weeks before you travel, but in emergency circumstances, a visit is valuable even on the day of departure.

During your pre-travel consultation, your practitioner will make sure your routine vaccines, such as measles, are up to date and recommend needed travel-related vaccines, such as hepatitis A and B, typhoid, or yellow fever. Pre-exposure rabies prophylaxis may be appropriate, if you are going to be in areas where there are stray domestic animals.

If you are traveling to a tropical or subtropical region, you'll need to use insect repellent and consider malaria chemoprophylaxis, depending on diseases endemic in the region. If you are traveling to a malaria endemic region, it is critical that you check which antimalarials are appropriate for the area.

If you are going to a disaster area or some very remote places, bottled beverages may not be available, and boiling water may not be an option. You should bring your own water filter and chemical water purification method. You should use treated water to wash dishes, brush your teeth, and wash and prepare food. When possible, drinking boiled water and eating food that is cooked and served hot is safest.

Even with food and water precautions, you should still bring Imodium® and a broad-spectrum antibiotic -- a quinolone or azithromycin is good -- to treat diarrhea, which may be inevitable. Also be sure to pack extra of any regular medications you take, in case of delays returning home.

If you're going to be in a country where TB [tuberculosis] is endemic, get a TST [tuberculin skin test] before you leave and 8 to 10 weeks after you return. Drug-resistant TB is of increased concern in many countries. To prevent TB and other respiratory infectious diseases that can be spread through the air, you might find it helpful to carry your own masks or N-95 respirators, depending on which is appropriate. For best protection, fit-testing of respirators should be done.

There will probably be little infrastructure support available during your mission. Even if basic needs are covered by your organization, you need to be prepared to be self-sufficient. US standards of hygiene may be difficult to adhere to with limited medical supplies. Consider packing personal protective equipment, such as safety glasses, latex gloves, surgical aprons, N-95 respirators, and masks. Pack soap and alcohol-based hand sanitizer. In addition, pack shoes that cover your entire foot and have thick soles.

If you find yourself working in extreme weather conditions, monitor your co-workers, and have someone do the same for you. Heat and cold can cause confusion and loss of consciousness. In general, it's a good idea to pair up with another responder so that you can monitor one another's mental status. The emotional challenges of this type of work can be overwhelming.

For your own mental health, limit on-duty work time to no more than 12 hours a day, and rotate work assignments between high-stress and lower-stress functions. Stay hydrated, eat healthy foods, and take brief breaks throughout your workday.

At least one third of aid workers report anxiety and depression after returning home, even though many reported that their time overseas was positive. If you find yourself having problems with depression, a mental health professional can help you readjust to your home environment.

Your health and safety are important because the work you do is critical to relief efforts. For more information about healthy travel, visit http://www.cdc.gov/travel.

Thank you, and good health.

Web Resources

Travelers' Health

Food and Safety

Insect Protection

Illness and Injury Abroad

Relief Workers

Department of State Travel Information

Phyllis Kozarsky, MD, is an expert travel health consultant for CDC's Travelers Health Branch, whose focus is to promote travelers' health and to prevent introduction of diseases related to animal importation to the United States. She is an editor of CDC's Health Information for International Travel, also known as the "Yellow Book."

Dr. Kozarsky began her CDC career in 1993. She is a Professor of Medicine and Infectious Diseases at Emory University School of Medicine, where she is also medical co-director at TravelWell, an Emory Healthcare-affiliated program aimed at providing pre- and post-traveler health services to international travelers. Current research efforts have primarily focused on issues in clinical tropical medicine and travelers' health, including the epidemiology of travel-related infections.

She received her bachelor's degree from Hobart and William Smith Colleges in Geneva, New York. She received her medical degree from Albert Einstein College of Medicine in New York and did her infectious diseases training at Emory-affiliated hospitals.

She is the author of many peer-reviewed articles and is a member of many professional organizations, including the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene.

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