Medical resources
General Information
Thanks to Dr. Graham Fry, Director, Tropical Medical Bureau, for the information provided in this section. Please note that the information given is of a very general nature. It must not be used in place of a detailed medical consultation under any circumstance. Dr. Fry can be contacted through the Tropical Medical Bureau in Dun Laoghaire, Co. Dublin.
The decision is finally made, the destination and scope of work decided, the family are both proud and distinctly distraught - so, what’s next? Well, many organisations will insist on a medical certification confirming that you are in good general health, after all nobody wants you sick overseas - least of all you yourself! This pre-departure health check will cover four main issues which should be carried out in every case:
- Checking that the volunteer is in good general medical and psychological health sufficient for their destination.
- Obtaining base-line levels for various simple blood tests so that these are available if sickness occurs and comparisons need to be made. I suspect that even some doctors would consider this a little over-the-top, while the other 3 points are sound
- Ensuring that required and recommended vaccines are up-to-date for the destination and that issues relating to malaria prophylaxis are clearly understood.
- Organising whatever is required to allow for easy contact between the volunteer and the home medical centre in case medical problems should arise while abroad.
While abroad
Arriving into a new situation, surrounded by a new family of other volunteers and often trying to learn a new language (let alone a new set of values and protocols!) is a really daunting task. Exciting as it is, during these first days the individual volunteer may frequently wonder why on earth they decided to leave family and friends back home. The support of their new colleagues is essential and the volunteer needs to learn both patience and pacing. Trying to do too much initially will lead to exhaustion and this may weaken the body and, for instance, allow a mild stomach upset become more serious. The lack of medical facilities may increase the individual’s personal stress levels as they try to convince themselves that they may not actually have contracted a severe fatal bug in their first days in the tropics! In many situations there will be a series of formal or informal orientation sessions with the other members of the team and this allows some semblance of normality to take control.
Specific health issues
Probably the one weakest part of any individual’s health is their bowels. Taking care of this organ - especially in the first weeks - is essential and it is worth its weight in gold for general well-being and overall job satisfaction. The volunteer needs to remember that the other members of their team may have been there for some time and so they have adapted somewhat. Mind you, even after many months you will still be liable to various gut wrenching parasites, so care is always needed. Sun exposure and lack of sufficient clean water may lead to dehydration, especially if the workload is heavy and it requires the individual to travel extensive distances between their work sites. Salt depletion is very common in the first few weeks (excessive perspiration, etc) and this requires a careful balance between replacement and over indulgence. Salt tablets should be avoided and just sprinkling food with sufficient table salt should replace what is missing.
Personality clashes
The new working companions may not have been the volunteer’s first choice under different circumstances! This is their new 'tropical family' and learning to live together with each others’ peculiarities is often quite a feat. Volunteers tend to be individuals with a strong outgoing personality and with a high belief in their activities and possibly also their ability to discern what is right and when others are wrong. Stir all this group together, add in a touch of isolation, poorer social activities (frequently none, except a good book - but too dark to read properly and many mosquitoes attracted by the light), add in some ill health and you have the potential powder keg waiting to explode. This is where a good balanced team leader is go so important to ensure that any potential conflicts are dealt with at the earliest opportunity and that team members have the chance to express themselves but are also given clear leadership. The good listening ear of the more senior members of the group (perhaps a respected local friend) often abates the situation before disaster occurs.
Stress, Strain and Sex
There can be little doubt that working in the tropics has its own set of stressful situations. Living among this newly found family and surrounded by many with a different set of values and regularly spending time travelling great distances between sites may lead to an unusual sense of dependence and friendliness between volunteers or volunteers and some of the local population. Friendships, which would never have seen the light of day back home, race forward at an unexpected pace. This sense of the normal need for companionship, coupled with a few drinks too many, may lead to an unfortunate situation. Knowing your limits and recognising the potential consequences of each and every action at an early stage may help to control a situation before it spirals out of control. [Remember what your mother always told you!!]
Malaria protection
In many regions of the tropics the risk of malaria is high and the individual needs to be constantly aware of how to protect themselves. This can be summarised as the ABCD of malaria protection:
A - Avoid the mosquito bites (repellents, nets, cover the exposed areas of the body etc);
B - Being aware of how this serious disease can become so rapidly worse with fatal consequences;
C - Careful attention to any possible symptoms so that a rapid diagnosis can be made; and
D - taking the correct drugs to protect against the disease.
There is no perfect drug which provides 100% protection without side-effects for all travellers. Each individual is just that - an individual who requires personal attention from the medical practitioner looking after them to ensure that they have the right drug for their personal circumstance. Nevertheless, after all the care and attention, it is up to each individual to make the crucial decision as to whether or not they will follow that advice while they are abroad.
This is where the ‘local experts’ come into play as mentioned above. These may be the volunteers who have arrived just a few months before you but have now become ‘experts’ and they regularly dish out significant medical advice to any who will listen. For the newly arrived volunteer this is an extremely confusing situation as now they have to make a difficult decision. Do they listen to the medical practitioner they met at home (perhaps 6,000 miles away!) or to the local colleagues and people who seem to know the situation so very well? Well, this is where the 24/7 contact with medical cover at home comes into play. Of course the volunteer should listen to what is being said locally but then check it through with their medical adviser at home. The final decision will rest with the individual volunteer but at least they will have a more balanced platform on which to base their decision.
Accidents overseas
Every year we hear stories of volunteers getting caught up in horrific accidents sometimes with a fatal outcome. Most of the organisations sending volunteers overseas have very strict rules regarding driving while overseas and these are there for very good reason. Nevertheless accidents do occur and it is essential that protocols are in place prior to this to ensure that the best possible treatment is available at all times. The presence of adequate medevac insurance is also essential so that this financial worry does not lead to unhelpful and less than ideal decisions being made.
TMB
The Tropical Medical Bureau has offices throughout Ireland: the central Dublin office can be reached at 01-671 9200. To make an appointment, visit their online booking service.
Irish Society of Travel Medicine:
“The Irish Society of Travel Medicine (ISTM) comprises a group of doctors, nurses and other Health Care workers who are interested in providing a uniform high standard of service on all travel related health matters to anyone travelling to or returning from overseas”. See www.istm.ie for further details, including a list of GPs by county.
WHO
The World Health Organisation’s (WHOs) publication, International Travel and Health, is available online. It includes a section on health risks and precautions to take when travelling, and regularly updated disease maps. You can access the WHOs Weekly Epidemiological Record at www.who.int/wer/en/ .
International Association for Assistance for Travellers
International Association for Assistance for Travellers provides contact details for English speaking doctors in various countries who are willing to see travellers.
Fit for Travel
Fit for Travel is a website provided by the NHS in Scotland that contains information for travellers on everything from accidents to yellow fever infected areas.
Mobility International
Mobility International: “Empowering people with disabilities through international exchange and international development to achieve their human rights,” Mobility International has useful contact lists and links.
HIV/AIDS
A complete directory of countrywide support groups, organisations and clinics is available from Dublin Aids Alliance at The Eriu Centre, 53 Parnell Square, Dublin 1.
For more information, phone 01-873 3799 or email: aids_alliance_dublin@hotmail.com. Freephone 1800 459 459 for more information about AIDS helplines nationwide.
