WHAT CAN GO WRONG
It might surprise you but not all travel clinics have staff that is specifically trained in this area. There is no compulsory requirement for a nurse, doctor or pharmacist to undertake training in travel medicine before providing this service and at present, the area remains unregulated. The Faculty of Travel Medicine is actively trying to change this but before attending any clinic, you should ask what training the staff that will be advising and vaccinating you have undertaken. Some key courses they may have done are the Foundation or Diploma in Travel Medicine, The Certificate in Travel Health or the entrance exam for The Faculty of Travel Medicine.
We have put together some factual accounts of what can go wrong with your health abroad. Although we have changed the names of these travelers, their experiences are real and have been shared with us by travelers that we have met and assisted.
Please click here to read more about unregulated and inadequately trained travel clinic providers.
“I was told I didn’t need the yellow fever vaccine”
Mary had booked a trip to the Gambia – a country that has yellow fever and getting the vaccine is generally advised. She had asked her pharmacist whilst she was picking up her prescription for Hepatitis A injection if she needed yellow fever too and was advised that she didn’t. Because yellow fever vaccination is not mandatory to enter the Gambia, the pharmacist, who was not trained in yellow fever was misinformed and advised her that she didn’t need it. Mary could have gone to the Gambia and contracted yellow fever which can be fatal. Thankfully, we saw Mary 2 days before she went and gave her a yellow fever vaccination. The rules and regulations around yellow fever can be complicated and it is vital that the health care professional advising is fully trained.
“I was given anti-malarial tablets that I didn’t need”
Keith was visiting Thailand, Cambodia, and Vietnam for 4 weeks and came to us for his rabies course. He had been advised by a nurse that he needed to take anti-malarial tablets and was given a private prescription for these. After we assessed his trip, we were able to let him know that he did not need to take tablets to prevent malaria. Whilst all these countries have malaria, the risk varies enormously within them and anti-malarial tablets are not always necessary. Again, health professionals that are not trained in travel medicine, often make a general recommendation rather than looking specifically at each travelers risk. As much as we love giving vaccines and anti-malarial tablets, it is also our job and responsibility to advise you when you don’t need to take medication or have vaccines administered.
“I contracted Malaria in Angola”
James had spent several years working intermittently in Angola as an engineer within the oil industry. He had always taken the correct anti-malarial tablets as he was fully aware that Angola was a high-risk country. James was taking Doxycycline for the prevention of Malaria. He was getting no side effects and was faithfully taking his Doxycycline every day with his hearty, chef made breakfast. After the chef unexpectedly left, breakfast was not as substantial and because James continued to take his Doxycycline on an empty stomach, he began to feel slightly nauseous and stopped taking his malaria tablets. Three weeks later when James was at home in the UK, he developed flu-like symptoms with a high fever. James was diagnosed with malaria and admitted to a high dependency unit. Thankfully, he made a full recovery and continues to work in Angola. He now takes his anti-malarial tablets with his main evening meal.
Jame’s story is a reminder of not only the importance of completing a course of anti-malarial tablets but that they should also be taken as prescribed. In this case, with a substantial meal.
“I got bitten by a dog in Thailand”
Laura was spending 2 months studying in Thailand. One week before Laura was due to return to the UK, she walked through a pack of dogs and received a bite from one of the dogs to her upper thigh. Laura attended a clinic in Thailand and received one dose of Rabies vaccine. She then returned home to the UK where she was referred to the local infectious diseases unit to continue a course of ‘post-exposure rabies vaccination’ over the next month. This involved her having another 4 rabies injections.
For many travelers, the risk of sustaining a potentially rabid animal bite is probably low. However, Rabies can be a fatal disease and sourcing treatment abroad might be problems which can result in a delay in getting protection established. For travelers that have not had any rabies injections before they travel, this is compounded by the fact that part of the treatment that is recommended (immunoglobulin) is extremely unlikely to be available. This was the situation Laura found herself in. Had Laura received a course of rabies injections before she traveled to Thailand she would have had established some rabies protection and would only have required 2 booster doses after she was bitten. We are very pleased to tell you that Laura did not go on to develop Rabies.
Here is a selection of resources that our clients have found useful. If you think there are any sources of information that others might benefit from, let us know about them.
Fit for Travel: There are too many countries for us to list on our site but this fantastic resource will give you an idea of the vaccines you should be thinking of getting, has interactive malaria maps preventative travel health advice.
IAMAT (International Association for Medical Assistance to Travellers): Provides impartial and accurate travel health advice and coordinates an international network of qualified medical practitioners to assist travelers in need of emergency medical care during their trip.
The Bloodcare Foundation: No-one wants to think about it but if you are involved in an accident or are taken ill whilst you are overseas and require a transfusion before you can be evacuated, can you be sure that the blood you will receive meets the standards of your national transfusion services? In many countries, there is always an acute shortage of blood, which is far worse than anything we ever have to face in the USA or Europe. To overcome these difficulties, the Foundation has made arrangements to provide, in an emergency, blood to expatriates and travelers.
Foreign and Commonwealth Office: Essential information for countries throughout the world.
Travel Insurance: If you were thinking of going without it, have a look at the FCO travel insurance page for what your medical bills could run into with no or inadequate insurance cover. There are too many insurance providers for us to recommend specific companies but the FCO has good information on what to consider when buying insurance for your trip.
European Health Insurance Card: replaced the old E111. Application is free but be aware there are some unofficial websites that will charge you if you apply through them.
Altitude Sickness: Information on how to prevent altitude sickness