Nee-Kofi is back to talk about situational awareness, trauma, and security. He'll talk about pre-trip planning, do's and don'ts, and post-trip considerations. Again, echoing the teaching point in this course that once you become mentally or physically incapacitated, you now become part of the problem. >> So, today, we're going to be continuing the lecture series on caring for yourself before, during and after travel. Specifically, we're going to be talking about situational awareness trauma and security for yourself before, during and after a trip. The objectives of our lecture today are threefold. One, to provide you with some guidance and resources around pre-trip safety preparation. Secondly, to discuss some do's and don'ts regarding personal safety and security while you are in a foreign environment. And last, to suggest a few post-trip actions to enhance your well-being. So, the first point I'd like to make is that, is that humans are complex beings. We have several domains including the mental, physical, emotional, and some would add, spiritual, all of which are required to be pretty high-functioning for you to function as a global or humanitarian responder. So I'd like you to keep this in mind. If, during the course of relief mission or volunteer work, you become ill, injured or otherwise incap, incapacitated, you then become a burden on the local system. And this effect is even more magnified, if you are in a low-resource setting that has very scarce resources. So, your primary objective as always to firstly protect yourself, secondly your crew, and lastly, the population you're there to serve. So before you jump on a plane headed to your destination, I think it's in, incumbent upon you to plan, prepare, and prevent. There are several facts and variables you should know about the environment before you arrive. For example, what is the local climate like? Is it hot? Is it cold? Is there a 30 degree to 50 degree Fahrenheit difference in daytime versus nighttime temperatures? What is the local political situation? Is it election time? Are there protests? What are the neighboring country politics? Is the, are the neighboring countries unstable? Are they engulfed in a civil war? Are there refugees fluxing into the environment you're, you're going into? What is the local burden of disease? What are the infectious exposures? For example, in 2014, we have Ebola outbreaks in West Africa. And in 2002 to 2004, there was a SARS epidemic in East Asia. Is trauma and violence rampant in the environment? Are there terrorist bombings, for example, as we have seen in East Africa and the Middle East? So, what is the local road system like? Do they drive on the left, the right? Are roads safe in general? What about physical and safety or security concerns of people of your citizenship? Are there issues with abductions, violent crimes targeted specifically to folks of your national origin? Do you know where the safe and unsafe neighborhoods are in the environment you're going into? What about technological and financial safety considerations? Do they accept credit cards, for example? What about when you log onto the wi-fi, or the internet? Do you have a safe and secure connection? Will you be at risk for identity theft? And finally your, if you have travel insurance, what sort of benefits will your insurance company cover? Will they medevac you to a destination? Will you receive on the ground care and support from? Those are all I think really important considerations to know before you head off to your destination. So let's discuss some resources that you can obtain some country facts. So, for example, the US Central Intelligence Agency, the CIA, has a World Factbook. It is an excellent resource to learn about the politics and the demographics and the geography of the environment you plan on going into. The United States Department of State has a Safe Travel program that also has very valuable information on many countries. And finally, the US Centers for Disease Control and Prevention, the CDC, offers specific medical related and infectious disease related information on many foreign destinations which you should look at before you head off. So there are even check lists available to help you consider everything from travel documents you should take, vaccinations you should receive, and what, what kind of equipment and clothing you should pack. The U.S. Department of State offers some very America specific, or some North America specific resources. However, there are regional specific similar sites. For example, in the European Union in South America and Southeast Asia. So you should become very familiar with what's available for your region. On the ground, it's really important for you to consider what your most likely exposures and dangers will be. Especially, if you're in a tropical environment or a low- to middle-income country. We know globally that road traffic injuries are the number one cause of morbidity and mortality of foreigners, especially motorcycle and car accidents. Secondly, infectious diseases and fevers. If you're going to a malaria endemic region, be very cognizant and careful of prophylaxing yourself and preventing yourself from being bitten by mosquitoes. Diarrheal and gastrointestinal illnesses are very common exposures for travelers, especially in warm and tropical environments. Consider the risk from theft or physical assault, especially if you're in a more urban environment. And finally, if you're a health care worker, you need to consider strongly blood and respiratory borne infections such as HIV and tuberculosis. So here are some tips for you on how to stay safe during your travel. I recommend when you arrive talk to locals, especially taxi drivers, concierge workers at hotel front desks. Read the local newspapers. Listen to media. Get very familiar with all the issues on the ground. Play, pay, pay especially close attention to your physical safety. Communicate clearly, so there's no confusion about your movements, why you're there, what you're doing. Know the local layout, know where the safe and unsafe neighborhoods are. And again by talking to people on the ground you can become familiar with with these new answers. And lastly, know the local emergency access number for reaching police or ambulance if those resources are available. So regarding medical and safety specific precautions, I strongly recommend that you evaluate your source of drinking water critically. Evaluate the source of your meals. What sort of environment were they prepared by? Whom are they prepared? I would strongly recommend taking an antidiarrheal treatment along with you. For example, ciprofloxacin. And even consider taking an emergency diarrhea kit, which is simple and contains oral rehydration salts that you can simply empty into a bottle of clean water. If you're a healthcare worker in particular, it's going to be really important for you to take personal protective equipment. When I travel to do emergency-related work, when I work in acute care settings or an ambulances, I take gloves, I take goggles, I take simple masks, I take N95 respirator masks and I take plastic gowns in case there's a lot of bleeding or body fluids. So here are a few do's and don'ts around your physical safety when in a foreign environment. Use caution, especially at night. Travel in groups whenever possible. Avoid jewelry, watches, and anything flashy. And pay a special caution with road travel. Use seat belts whenever you can if available. Avoid riding on scooters and motorbikes at all costs as these are an especially high risk way to travel. Consider taking mace or even a whistle if they're locally and culturally appropriate. And do report events to local authorities especially if they involve crime, violence to you. Or, if they involve theft of any sensitive documentation like your passport. Do know if and where your home country embassy is located and how to access it. Do keep a backup copy of your passport, your credit card, and any other critical identifiers in a safe location, preferably in a separate location than where you have your passport and all your original documents located. For example a hotel safe or with the hotel front desk staff or with the members or the organizers of your host institution. And do leave local contacts with family, friends and co-workers in your home country and again, especially when you're travelling to higher risk areas. And finally, upon return to your home country, if you've unfortunately experienced any injury or violence do get a prompt follow up care and assessment. I would hope you would have received this in your in the foreign country, before arriving back in your home country. If you are exposed to an infectious disease do seek care with a, with a requisite specialist. And finally, if you do have any psychological trauma, I recommend you seek professional advice and maybe even counselling. Other things you could do upon return to your home country, consider debriefing you know, with family, friends, or professional. And this may help you cope with any stressors or any potentially traumatic things you witnessed. Consider journaling or, or maintaining a diary to reflect on events as a way of processing them as they occur or even upon your return. And finally, share your story, but responsibly. It may resonate with others, it may be inspirational to others, or it may provide some solace to you or for others. So to conclude our lecture, we reviewed some pre-departure safety planning and preparation items. We reviewed some in-country do's and don'ts for your physical safety. And we reviewed tips upon returning to your home country to help you process and debrief sort of psychologically. So, remember be safe, so you can be an effective, happy, engaging global and humanitarian responder.
