Dr. Davis is an expert in travel medicine with a degree from the London School of Tropical Medicine and Hygiene and is here to give you an overview of Travel Health 101. What vaccines you need and what diseases you might be vulnerable to, what medicines are must haves for you and where they do and don't work, and what are the most likely ways your health can be at risk. We'll ask doctor Davis some in studio questions after the talk so please stick around. >> So in this next section, we're going to talk about travel health for the global health provider. And what does that really mean? Well, the key concept here is, whenever we travel, no matter where we're from, we're all vulnerable. Travel medicine is a huge topic and we can't cover it all in this segment. But we can boil it down to some common sense, no nonsense points. So the first idea is this idea of context. Doesn't matter where you grow up, but if you're traveling abroad, there are new risks and new health considerations. So this idea of context can be hard to put our finger on. There's just so much information out there, and travel medicine is such a big topic. So we have to go to trusted sources. Two of the best and well respected travel sources are the WHO and the CDC. These are resources that can give you real time, up to date, accurate information about the risks of going to any country in the world. So what are the questions that we need to ask ourselves as responsible travelers and as global health providers? So the first question we've got to ask is, what immunizations do I need? There's no quick and easy answer. There's no set recipe. It all depends on where you're going and where you've been. So again, you need to go to these trusted resources. You can plug in where you're going, what immunizations you might already have, and then get a sense of what you need before you go. Here are some examples of some immunizations that a global health provider might need. [NOISE]. The next thing we need to talk about is vector-borne disease. For all intents and purposes, this means insects. Critical concept. The insects and the diseases, if you grew up in India, are different if you're traveling to Africa or South America. There's different insects, there's different diseases, and there's different drug-resistance patterns. So, if we're going to prevent insect bites, there's lots of ways we can do that. Probably the cheapest and most effective way is good bug spray. And what that really means is, a bug spray with DEET. I wouldn't use a bug spray with anything less than 20% DEET. You really want to go big here. The next strategy we can think about is promethrene impregnated clothing, and this has bug repellant in the actual fabric itself. The last piece of the puzzle is a good bed net. You won't need this everywhere in the world, but there are some parts of Africa, some parts of Asia, where this can be really effective at preventing mosquito bites in the middle of the night. Another big topic in travel medicine is malaria prevention and prophylaxis. Again, this is country and region specific, and the prophylaxis that you take in Asia or India is vastly different than what you might take in South America. Probably the most important take-away message for malaria prophylaxis is that compliance is key. You've got to take the medicines as directed for them to work effectively. If you don't, then your trip could be ruined with a bad case of malaria. We've spent a fair bit of time talking about infectious disease, immunizations, malaria, but what really hurts people, or kills people, internationally is injuries and accidents. So, let's break that down a little bit. Car accidents are a huge source of morbidity and mortality in travelers, and car accident rates in some places like eastern Africa are staggeringly high. What does this mean? Well, it means wear your seatbelt, if at all possible. It means, avoid traveling at nights when accidents are far more frequent. So, what are some other ways that we can say safety conscious? Well, take somebody to that ATM with you. Have a partner, have a buddy. At night, lock your door or use a door jam even so you can't have someone pushing their way into your room. We also need to talk about sexual encounters. People have sex when they're traveling. Rates of sexually transmitted diseases are different in different countries, and the types of infections are different as well. So when in doubt, use barrier protection. And for all intensive purposes, that means condoms. The last thing we need to talk about is medical and evacuation insurance. So the key take away message here is the insurance that covers you at home probably won't cover you when you're traveling internationally, so you have to get separate coverage. Even for countries that have socialized health care, countries like England, when you're traveling abroad, you may not be covered. Most of these policies are reasonably cheap, but you really do need to read the fine print. Are pre-existing medical conditions covered? Do they cover medical evacuation? And are those amounts of coverage appropriate for the trip that you are on? Are there any activities that are excluded? Can you go mountaineering? Can you go hiking? Can you go scuba diving? You got to read the fine print. So let's summarize. Travel medicine is incredibly complex. Doing some self education and some research before you go is absolutely paramount to a successful trip. So, this is country and region specific. So go to those resources that I talked about. Do that research because if you're not taking care of yourself, you can't take care of others. >> Chris, thanks for joining us in the studio. >> My pleasure. >> That was great. Couple things just I wanted to ask you about. We talked about vaccinations and I think the thing that we want to just be clear is you know, Westerners going to low to middle income countries, we sort of looked at the, you identified the CDC websites and vaccinations that are needed, but what about the other way around? What about, for instance, people form Asia traveling to the US? Do they need to be protected or what risks do they run into? >> Sure. Now that's a great question, and we, we often don't think about that reverse situation. We're occasionally US centric here. But there are no, just to be clear, there are no official vaccine requirements to enter the U.S. but there is risk. And it's, in terms of resources and where someone might look, you want to go to your state department website from wherever you might be coming from. Or visit the WHO, which again, has a nice rounded picture, appropriately of vaccine requirements for various countries. But it's good to keep in mind that there certainly are disease epidemics and outbreaks in the US. For diseases that we thought were long ancient history. So we've got measles outbreaks in Disneyland. We've got measles outbreak in, in Colorado, here in Colorado. And then Pertussis as well is having a big resurgence in the US. So a focus on routine child vaccinations is, is important too, and making sure you're up to date. >> So it sounds like vaccination is probably more as an entry requirement rather than necessarily a risk. >> Right. There is, again, no entry requirement, but that's not, you know, just getting your pass to get into the country is one thing, but actually mitigating risk and keeping yourself safe is another. >> Got it. One thing that we see a lot of, and we know is ubi, ubiquitous with travelers is traveler's diarrhea. Could you just talk a little bit about that? Like, what are the risks, and then also, what do we do about it? What, what are the sort of general recommendations for treating that? >> Sure, another good question so, I'd say most people would divide the world up into three categories. You have places that are high risk for traveler's diarrhea. That would be, Southeast Asia. India, yeah the, the Eurasian sub-continent, middle risk would be places like Central America, and then low risk would be Europe and the US. Now, certainly there's, there can be issues with people from Asia coming to the US or Europe and getting diarrhea. Often times that's a change in their diet itself, rather than a bacterial cause. And so it's important to ease into things, and, and again the way we think about how to treat that. Firstly, it doesn't have to be treated with antibiotics, it often is just self limiting, but if it is ruining your travel and you're just sort of, bed ridden because you're going to the bathroom so much, antibiotics can be warranted, usually ciprofloxacin or fluoroquinolone is a good antibiotic to have in your medical kit if you're traveling in the Americas. If you're travelling in Asia, a more appropriate antibiotic would be erythromycin. >> Got it. When does a traveler's diarrhea become problematic? What are the hallmarks of, just say when it's okay to stay put and take it easy versus when do you need to seek medical care? >> Sure, so. Often, traveler's diarrhea is just a nuisance. It's sort of a gurgly belly, and some loose stools, that's inconvenient, but isn't debilitating. But when you sort of cross that threshold, when you're going to the bathroom every hour, even couple of hours, when your hydration is a concern, where you're just feeling thirsty, that would be a red flag that you might want to think about antibiotics, think about seeing a healthcare provider for some hydration or even if that's oral re-hydration solution. And then red flags for what isn't traveler's diarrhea that sort of dysentery picture, it's important to keep that in our minds, too. That would be, big fever, actual pain, not just sort of gassy, gurgly unsettledness, but actual pain in your belly, and then blood in your stool. Those would be red flags. >> Chris, the global matrix of insurance and who pays for what and who's covered for what is becoming increasingly complex. Can you talk a little bit about that? And what I mean is, within insurance, who's at risk for where? And maybe we'll start with, Americans and Europeans traveling abroad, and what exactly are they covered under and, perhaps, give some anecdotes of sort of nightmare scenarios you've, you've heard play out. >> Yeah. There, unfortunately, there are a lot of nightmare scenarios out there, and usually, the cognitive pitfall is you think you're covered, but you're not. So let's take the example of a Brit. They have, the national health service, great service, gives them free health care in their country. If they are traveling to some other country in EU and you are just sort of thinking about the European union as, as taking care of their own. Unfortunately, that is not the case and often times Brits who are traveling to France or Spain, if they get injured or sick, are not actually covered by the NHS, and so they're left with an incredibly big bill. But let's step, step back and actually even talk about what the definition of travel insurance is be, because it's a hodgepodge. You know, on some airline websites that just might mean that you have flight forgiveness if you needed to change your flights or some compensation if your baggage gets lost. That's really not what we're talking about here. We're talking about two main services. One is, if you get sick and you need medical care elsewhere, are you covered? You know, to get medicines, to be seen by a doctor, to get x-rays, etcetera? And then there's, the other end of that, or the other leg of that, is getting you back, or evacuation insurance. And it really is a hodgepodge. And you really, unfortunately, have to spend some time reading the fine print on what your, what coverage, if you bought some, what it actually, what it entails. >> Sounds like most of the time Westerners traveling outside of their home countries are going to need to get some form of additional coverage. Is that accurate? >> I think that, that is certainly a good message. There are, certainly there are some people who have a great insurance and they are covered when they go abroad. But most people, are going to need some sort of rider or other policy to cover them while they're traveling. And it's fairly reasonable. People estimate that it costs about, I don't know, five or 10% of the trip value. So a longer trip, obviously you're going to need a more expensive policy. Shorter trip, less so. But it's worth it because when you think about what the cost for a medical evacuation is, and this is really any part of the world, but it runs upwards of $100,000. That's going to have, bankrupt most people. >> Yeah. Let's talk about people because we get this a lot. In the US or any country where the, the cost of healthcare is exceptionally high compared to other stand, global standards. Say someone from South America comes to the United States, and is doing work here, and gets injured. What do they have to worry about? >> Well there's, I think. I want to just hone in on two things there. First is, that you use the scenario where someone got injured rather than getting ill. And I think that's just important that to, to reinforce that that's actually the far more likely scenario. Now we spend a lot of time again talking about infectious disease, but it's really the, the injuries and the car accidents that by the numbers affects most people. So, it's worth, one asking around in your, in your home country, about, who are the actual reputable dealers. And you can find, unfortunately, there is some, fraud online, and so it's, it's, again, worth doing a little bit of research and due diligence about making sure that the product you're buying is actually going to deliver when you need it. But absolutely, the health care in the US is when we compare it to other countries, is astronomically expensive. And so, you want to make sure that whatever policy you have is going to cover you for the country you're going to. >> Got it. Chris Davis, thanks for joining us. >> Jay, my pleasure.
