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Pre-Travel Health Preparation for Aid Workers
Submitted by Liz Rosies on January 22, 2003 - 1:00am.
Many aid workers, concerned with a desire "to make the world a better place" often overlook the need to remain healthy when involved in assignments overseas. With ever increasing reports of war and internal conflicts along with economic crisis and natural disaster, aid workers often find themselves in areas of poverty with a higher risk of disease.
The travel health input from an aid worker's doctor or nurse will often vary according to the support received from a sending organisation - ideally a full country-by-country health briefing should be provided by the sending organisation. Health needs are diverse, with vaccination and malaria advice required for often-complex situations. Added to this is the psychological support required for working in highly stressful areas of the globe. While many doctors will be able to offer a full pre-travel service, some workers will need to consider visiting a specialist medical centre where a full medical can be given prior to leaving. A trip to the dentist can prevent unnecessary treatment while away. Many organisations also require their workers to undergo psychological testing prior to acceptance.
Vaccinations should be given after a full assessment is made of the situation and countries to be visited. Workers should consider both vaccine and non-vaccine preventable disease risks and methods of prevention. For those integrating with refugee populations, vaccination against measles is essential.
Many of the malaria zones of the world are situated in areas of poverty and unrest. Workers should obtain advice on suitable malaria prophylaxis related to their personal situation and length of time away. Advice regarding bite prevention is important along with the recommended use of insect repellents and impregnated bed nets. In remote malarious areas a malaria standby treatment kit is also advised. It should be stressed that the kit is for use in emergency situations, and should always be followed up with a medical consultation. As the medication could be taken for the first time in a medical emergency, full information about the drugs and the potential side effects should be considered. It is possible that medication will differ for workers travelling to the same area - this is due to consideration of personal circumstances and risk factors.
Research has shown that death following intentional crime accounts for the highest mortality rate among humanitarian workers. Physical hazards are part of any aid worker's assignment and include terrorism and intentional harm. Advice relating to personal safety should also be discussed in the pre-travel consultation.
Accidents, while not the leading cause of death among this group, still pose a threat in countries where poor economies are associated with decaying structures and inadequate roads. Accidents also increase the threat of HIV and Hepatitis B and C due to the possibility of contaminated blood transfusions.
First aid techniques and the use of a well-equipped first aid kit and sterile medical pack are recommended for most travellers. All workers should be aware of their blood group and carry copies of essential medical details, including their health insurance policy. Workers will also need advice related to climate adjustment as well as the need for clean food and water in often-desperate situations were such a commodity is considered luxury.
Culture shock and stress are commonplace among humanitarian workers and should be addressed in the pre-travel consultation. Issues such as loneliness, inadequate skills for the job assigned and personality problems are often a major cause of repatriation. While those on short term projects are sometimes overwhelmed at the immensity of the task, their often lack of experience, language difficulty and vulnerability put them at a high risk of psychological problems. For the longer-term worker, stress and exhaustion are often noticeable on return.
Many workers find themselves with problems when they return home. Those who have been living in remote situations with local populations often return with diarrhoea, fever and weight loss. Those who have been working on short-term projects overseas often return exhausted and feeling unwell. While symptoms could represent a number of differing diagnoses, it is essential that a full check up be given. Adequate debriefing and the option of counselling should be made available for those who have been in difficult situations while overseas.
Liz Rosies is a Registered Nurse with further qualifications in Travel Medicine. Working for TravelHealth Information Services she provides written information for articles and the web. She is editor and author of http://www.TravelHealth.co.uk/ and is associated with InterHealth a clinic based in London which provides medical care for aid workers.
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