We want to serve you better. Tell us how by taking our survey and get the chance to win a gift certificate for travel clothing and gear!

Being around for 52 years means we're doing something right. But we want to hear from you so that we can tailor our advice and programs to help you stay healthy abroad. What additional travel health information do you need to better plan your trip? Did you need the services of an IAMAT doctor? Are you satisfied with our correspondence? Do you access IAMAT materials with your mobile?



The survey takes less than 10 minutes to answer and will be available online until May 31, 2012. Your feedback will remain strictly confidential. Look for the survey result highlights on this Blog coming this Fall.

As a thank you, we'll put your name in a draw and choose three names randomly to receive gift certificates worth $100 from TravelSmith, Magellan's Travel Supplies, and Mountain Equipment Co-op.

We sincerely appreciate your feedback.

>> It's Your Turn, take the IAMAT Survey now!

Guest post by IAMAT Board member Shirley Cheng, MPH. Shirley has over 20 years of public health experience in both Canada and China. She holds a Master of Public Health from the University of Waterloo and a Bachelor of Medical Sciences from West China University of Medical Sciences.

Chest x-rays courtesy of Stock.XCHNG.

Today is World Tuberculosis Day. One hundred and thirty years ago, the German doctor Robert Koch discovered the bacteria Mycobacterium tuberculosis which causes tuberculosis (TB). TB continues to be a global health concern: In 2010, 9 million people suffered from TB, 1.4 million people died from this infection, and one-third of the world's population is at risk. The World Health Organization (WHO) has designated March 24 of every year as World Tuberculosis Day in order to raise public awareness of this infection (pulmonary TB being the most contagious). This year's slogan, "Stop TB in our lifetime", is a call to action for us to prevent the spread of TB, especially as we face challenges controlling multi-drug-resistant tuberculosis (MDR-TB) and extensive drug-resistant TB (XDR-TB).

Air travel and pulmonary tuberculosis
Travellers may recall the 2007 tuberculosis scare caused by a passenger who travelled by plane to various international destinations including the US, France, Greece, Italy, the Czech Republic, and Canada while he was suspected of having extensive drug-resistant tuberculosis. Some travellers who flew on the same planes accused him of selfishly putting their lives in danger. It was also the first case where the US Centers for Disease Control and Prevention (CDC) quarantined a person infected with TB. It raised many questions about the risk of contracting TB in an aircraft (as a result of travelling in a confined space for a prolonged period of time) and highlighted how easily infectious diseases can be potentially transmitted through international travel.

The airline industry follows the WHO Tuberculosis and Air Travel guidelines which indicate that people with infectious TB must postpone long distance travel while those with multiple drug-resistant tuberculosis must postpone all air travel. Some countries have their own DO NOT FLY list at their border services for public health reasons. Quarantine officers from the Public Health Agency of Canada, for example, work in major international airports to prevent infectious diseases and outbreaks. According to the WHO, no active TB case has been identified due to exposure on a commercial aircraft so far. This is because airplanes are built with HEPA (High-Efficiency Particulate Air) filter systems on board which kill germs when air is circulated in the aircraft. Travellers can rest assured that under normal conditions, cabin air is cleaner than the air in most buildings. Furthermore, aircraft ventilation systems are operating as long as the doors are closed even if the plane is on the tarmac. WHO advises ground delays should be kept to a maximum of 30 minutes.

So what are the risks of contracting TB when someone sitting beside you is coughing or sneezing? What precautions can you take to protect yourself?

Tuberculosis is an airborne disease. Symptoms include weight loss, fever, excessive coughing, loss of appetite, fatigue, and night sweats. Sometimes TB may be misdiagnosed as bronchitis or pneumonia. TB becomes infectious when a person with active TB releases the bacteria into the air through coughing or sneezing. Others nearby may breathe the air containing the bacteria into their lungs and become infected. TB is not spread by sharing cutlery, dinner plates, drinking cups, or toilet seats.

The critical steps for controlling and preventing TB is to make sure that persons with active TB get proper and timely treatment. If you have active TB, you'll need to be isolated until the culture test results are negative. Once you are no longer contagious, you can resume your normal activities and travel. To prevent drug resistance to the infection, you need to take the full course of medication for a minimum of 6 months which can take up to one year or more to complete.

As a frontline public health practitioner working directly with TB patients and their families, I often got questions asking: Why did I or a loved one get TB? Can I let my parents / grandparents / child fly back to visit relatives back home? What are the air travel restrictions for people affected by TB? The answer is that persons who have lived in or traveled to areas where TB is endemic, are at greater risk of developing tuberculosis. Persons can fly back to their home country after their sputum results turn up negative and they follow an established treatment regime. Income, housing conditions, lack of access to health services, social exclusion and other social determinants of health also play a role in TB infection. For example, data shows how healthy newcomers who have latent TB are at risk of becoming infectious within the first five years of immigrating. Unequal access to employment, education, and wealth distribution are all key factors contributing to physical and psychological stress.

If you are a TB carrier ask your local public health department official who is in charge of infection control, or your treating physician, to issue a letter explaining your health status and confirming that you are fit for travel in case you get asked at the border about your medications.

I hope this information reassures you that there is no need to panic about TB and instead, enjoy your vacation to the fullest.

Shirley discusses TB in the videos "Are you at risk?" and "The difference between TB infection and TB diseases" in Mandarin. If you have any questions for Shirley, please contact us.

You can find more information about TB from:

• STOP TB Partnership
  
• Bill & Melinda Gates Foundation
  
• World Health Organization
  
• Public Health Agency of Canada
  
• Centers for Disease Control and Prevention
  
  

Guest post by Caitlin Garlow, Communications Associate, Sabin Vaccine Institute.
Sabin is a non-profit organization working to eleminate neglected tropical diseases through innovative vaccine research and development, and advocating for improved access to vaccines and essential medicines for citizens around the globe.

Children getting medication to prevent NTDs in India. Photo by Esther Havens.	Schoolchildren in India. Photo by Esther Havens.

For health conscious individuals planning to visit other countries, there's a pre-travel checklist:
- Visit the travel clinic, check
- Catch up on necessary immunizations, check
- Research medical insurance, check

But even the savviest travellers may not know about all the diseases that are native to the countries they visit, how to avoid them or how they can help those affected by particularly devastating diseases that most people have never heard of.

Neglected tropical diseases (NTDs) are a group of diseases that are largely unknown to many people. Travellers probably won't find pamphlets about them in travel clinics and they may not be on the recommended shot list either. But these bacterial and parasitic infections are very common in countries in Africa, Asia and Latin America.

The seven most common NTDs - ascariasis (roundworm), hookworm, lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), schistosomiasis, trachoma and trichuriasis (whipworm) - impact one in six people worldwide, including 500 million children. The symptoms are different for each disease and can include rashes, nausea and vomiting, fever and loss of blood. Left untreated, these diseases can eventually lead to blindness, huge swelling of the limbs, severe malnutrition and anemia. These long-lasting effects help to perpetuate poverty by preventing parents from working and keeping kids out of school.

NTDs can be transmitted through insect bites, contact with contaminated food, water or soil and direct human contact. Cautious travellers visiting endemic countries can take steps to avoid contracting these diseases (for a specific list of prevention tips related to the NTD schistosomiasis, visit this post on End the Neglect by IAMAT president Assunta Uffer-Marcolongo), but should also consider how they can be a part of the solution to the global health problems created by NTDs.

And the solution is simple. A rapid-impact package that contains four pills can treat and prevent all seven NTDs. Pharmaceutical companies donate a majority of the pills, so the costs are limited to distributing the medicine and setting up treatment programs that communities can run themselves. As a result, the total cost of treating and preventing seven NTDs is only 50 cents per person per year.

That's why this year the Global Network for Neglected Tropical Diseases launched END7 , an international advocacy campaign that encourages people to learn more about NTDs and take action to help those who are affected. To show your support for ending seven NTDs, we'd like to invite you to visit our web site, www.end7.org, join our Facebook or Twitter, join our Facebook communities, and consider donating 50 cents to give one person the chance to live a healthy and productive life. Travellers interested in learning more about the causes, symptoms and treatments for NTDs can also take a look at the series of interactive fact sheets on our the Global Network for Neglected Tropical Diseases web site.

Travellers have the opportunity to do more than just see the sights when they visit new places. Becoming knowledgeable about important health issues in the countries they visit and advocating for those with tangible solutions can help people connect with the cultures they visit. Don't forget next time you're planning a trip to add learning about NTDs to your travel checklist.

Yesterday, Tullia Marcolongo, IAMAT's Director of Programs and Development was asked by Sean O'Shea from Global TV's Consumer SOS about avoiding medical scams abroad in light of recent reports from tourists being duped in Mexico.

Some common medical scams experienced by travellers include: - Taxi drivers taking commissions from private clinics to take ill tourists to their location. - Doctors overcharging patients for consultations and suggesting unnecessary procedures. - Clinics not accepting insurance coverage and asking for payment upfront by credit card or cash. Why is it important to be prepared with the names and locations of doctors and hospitals when people travel? In many countries the level of care is very different from what you expect back home. The standard of care and medical practices may not be what you're used to. As well, language differences are a huge barrier to ensuring that you get the care you need. Having the name of a reputable physician or clinic in case of an emergency can save you hassle and stress.

Photo by: Brian Lary courtesy of stock.xchng

You or your travelling companion should insist to be taken to a clinic that you know provides trusted medical care and the physicians on staff speak your language. Always make sure to get a detailed receipt that includes the date of treatment, diagnosis of the illness, medical services provided, and medication needed. This is essential to get reimbursed by your travel insurance company. Check the fine print of your policy to see which services are eligible for a refund and the proper course of action for making a claim. Here's more information on what to look for when purchasing travel medical insurance.

Are a lot of people uninformed about this need and if so why do you think that is the case?
Unfortunately, travel health is not always on top of people's minds when they're planning a trip. As travellers, we tend to focus on the destination, the hotel, the activities we'll be doing. We don't think about the possibility of illness and injury.

If you've booked a last-minute vacation, you're often in a rush and don't have the time to find out the health risks of your destination. For example, is there malaria? Do you need yellow fever vaccination to enter the country? What about food and water safety? It's important to make time to do some basic travel health research and consider the possible health risks of your destination. It's also important to consider your current health status and how you will cope in case of a medical emergency abroad.

What does IAMAT offer travellers?
Our non-profit organization offers travellers a Medical Directory of English speaking doctors around the world whose clinics have been vetted by us. Our doctors have been trained according to international health standards so you can expect the same level of care you are used to back home. They will help you navigate the local health system. Here's a complete list of what IAMAT affiliated doctors will do for you.

We also have easy to use downloadable materials on how to prepare for a healthy trip such as immunization recommendations and requirements, an online database of health risks and food and water safety for all countries, and information on travel and mental health - how to reduce travel stress, minimize culture shock, and deal with post-travel blues.

We'd like to hear from you. How do you plan for a healthy trip? Is travel health always at the top your mind when getting ready to go abroad?

>> See the Global TV segment on how to avoid travel scams.

As 2011 comes to a close, we would like to sincerely thank all our members for helping us continue to advocate for travellers' health. We could not have done it without you!

When IAMAT was created in 1960 by the late Dr. Vincenzo Marcolongo, the health of travellers was not at the forefront of the medical establishment. The incident that inspired his life's work - being called to treat a sick Canadian traveller in Rome - prompted him to create our non-profit organization to fill a growing need in an era of increasing travel.

Travel health is now an important aspect of international travel and we are proud of our achievements in the field. Thanks to the generous support of our members, we can continue our health promotion programs to reach more travellers, expand our medical services, and train more health practitioners from developing countries in travel medicine.

Thank you to all our members, including our 2011 donors who participated in our World Traveller Circle.

Wishing you a happy and healthy 2012 from all of us at IAMAT!

We recently had the chance to skype with Tian Lingling (Sandy) and Tian Rui (Tatiana). Our 2011 scholars just completed a six-week intensive training course in travel medicine at the Kaiser Permanente Honolulu Travel Health Center. This scholarship program is sponsored by IAMAT, thanks to the generous support from our members.

Currently, our scholarship program focuses on training Chinese scholars since China is one of the major travel destinations in the world. We are grateful to Dr. Vernon Ansdell, Dr. Johnnie Yates, and their colleagues at the Honolulu clinic for their invaluable mentorship.

Some background... Tatiana is a general practitioner from Beijing and has 3 year old twins. Her work at the Beijing International Travel Healthcare Center involves doing physical checkups for travellers coming to China. Her clients are mostly travellers, expatriates, and students from the USA, United Kingdom, Australia, Korea, and Japan. Tatiana likes travel medicine because it's an interdisciplinary field; travel health providers need to have a working knowledge of geography, epidemiology, international medicine, tropical medicine, just to name a few. Sandy is also a general practitioner and works at the Jiangsu International Travel Healthcare Center in Nanjing.

From left to right: Tatiana, Dr. Vernon Ansdell, Dr. Johnnie Yates, and Sandy.

She performs physical examinations for Chinese workers going abroad as well as for Chinese travellers and students mostly headed to the USA and Europe. The most interesting aspect of travel medicine for her is immunology – how vaccines are developed, the mechanics of protection, and understanding possible side effects.

What the scholarship means to them
Sandy says that the scholarship has given her the confidence to deal with different clinical situations, "It is a good opportunity for me to learn more about travel medicine and turn my knowledge acquired from books into practical skills to protect travellers. I was not sure how to approach cases before the training, now I have a sense of how to handle it and what I should pay attention to when a traveller comes to see me. The training is very helpful to us."

For Tatiana, the scholarship gives her the skills to improve her travel health consultations and an opportunity to advance her professional goals. "It really has helped me a lot. It has given me the chance to be trained by experts in the USA, leaders in travel medicine. It has broadened my view of travel medicine practice and given me a lot of information to take back to my clinic in China," she says. Sandy adds, "When I go back to China I can use this information to give consultations and give much better services for my patients who will travel all over the world. It is very important for my career."

How they plan to help travellers
Both scholars emphasize how the training has changed their approach to travel health practice. One key lesson learned is the need to provide detailed and thorough travel health consultations. "In China, we generally do not provide detailed consultations. Doctors administer travel vaccinations while providing the traveller with little advice and information on how to protect themselves," says Sandy.

Back home, they will teach their colleagues consultation best practices to ensure that the traveller can make informed choices. They learned that a successful visit involves giving advice tailored to the traveller's health needs and paying attention to the client's destination, trip itinerary, current health status, vaccination history, type and length of travel. Says Tatiana, "The goal is about enjoying travel, but getting the right information to ensure a healthy trip." Sandy agrees. She learned that many travellers feel that there is very little risk abroad, but if they do get sick, there are big consequences. "I want to prevent them from getting sick and protect them better, to make travel much safer so that they can enjoy it with minimal risk."

Learning about common infections like malaria in returning travellers was also part of the scholars' training. Tatiana is looking forward to developing protocols in her clinic to detect post-travel related infections. "When I return to China, I want to do research and write an article to raise awareness among doctors, who are not travel medicine specialists, on how to deal with post-travel infections. I want to break down the barriers between general medicine and travel medicine."

A typical day at the clinic
Everyday Tatiana and Sandy interacted with people travelling all over the world. Starting at 8am with consultations, they saw travellers from different backgrounds and health conditions. Finding solutions to ensure a healthy trip for a traveller with environmental allergies or a senior with mobility challenges taught them the dynamics of travel health. Considering the risk of yellow fever, malaria, travellers' diarrhea, jet lag, altitude sickness, food poisoning, mental health concerns, culture shock, air pollution, adverse reactions to medications, and understanding travel medical insurance are all part of the training. They also participated in rounds at the Kaiser Permanente Ambulatory Treatment Centre, including the HIV clinic and Hepatitis clinic.

Part of the day was also dedicated to individual study and case study research, as well as making weekly lunchtime presentations to their colleagues on various aspects of travel medicine, including travellers' diarrhea, Hansen's Disease (also known as leprosy), leptospirosis, and risks affecting immuno-compromised travellers.

Benefiting from experiential learning
Their training also took them to a travel medicine conference in San Diego to learn about the latest developments in the field and to network with experts. Sandy and Tatiana also had the opportunity to visit Houston to explore research possibilities on travellers' diarrhea.

They also went to Tijuana, Mexico where they learned about the risk or rabies, Hepatitis B (due to many tattoo shops in the area), road injuries, and travellers' diarrhea, common risks in Mexico. It was an eye opener for both of them. Being away from home has made Tatiana pay more attention to food and water safety, living conditions, cultural differences, and how these affect travellers. Hands on training also occurred on Molokai Island, in Kalaupapa, a former leprosy colony. The scholars learned about Hansen's Disease and made comparisons with the situation in China.

On their days off, Sandy and Tatiana enjoyed sightseeing, going to Pearl Harbour, Kilauea volcano, exploring the parks and beaches, eating Hawaiian specialties, as well as snorkeling. An eighteen hour difference separated the scholars from their families, but keeping in touch by internet made it easier. "It's hard to be away, but it's worth it! This is really a fascinating, challenging but rewarding training experience." says Tatiana.

Says Sandy, "I really appreciate the chance that you provide for us to train at the Kaiser Permanente clinic. The doctors here are very nice, taking good care of us, and teaching us the vocation. It's a wonderful experience for us that we will never forget."

To learn more about our scholarship program, go to: International Travel Medicine Education Program.

Did you know that the leading cause of death among travellers are road collisions? Statistics are consistently showing that the highest risk to travellers are traffic related injuries. According to a recent study done between 2007 and 2009 by the US Department of State on American travellers and expatriates, 32% of deaths reported were related to road accidents.

As international tourism rates are on the rise and more people around the world are buying cars, many road safety and health advocates are sounding the alarm. In fact, the UN has declared 2011-2020, the Decade of Action for Road Safety.

Left: Road traffic in Shanghai. Photo credit: Mr. Uncut	Right: Sharing the road in Manila. Photo credit: Mr. Uncut

Why so many injuries?
There are many factors contributing to road related injuries abroad. During travel, it's common to ignore or be lax about road safety rules we uphold back home. The instinct is to do as the locals do, but this can get you into trouble.

In addition to the typical traffic risks we encounter every day back home, there are additional challenges to take into account during your trip:

• Fatigue due to jet lag can impair your driving.
• Distractions, getting lost on unfamiliar roads.
• Different driving culture (ie. honking, speeding, no signalling).
• Unfamiliarity with driving and pedestrian rules (ie. driving on the opposite side of the road, roundabouts, no right turns on red lights, pedestrian right of way).
• Poor road lighting and uneven road surfaces, no shoulders.
• Lack of traffic warning signs and unprotected contours (ie. tight curves, hidden roads and driveways, cliffs).
• Road safety rules are not enforced.
• Overcrowded roads and mixed use traffic (ie. all types of vehicles share the road, including animals and pedestrians).
• Vehicles may not have safety features like seat belts or airbags; poorly built or not maintained properly.

You should also consider the medical consequences of being involved in a traffic accident. Many countries do not have Emergency Medical Services. Not having a paramedic at the scene can contribute to further injuries.

Furthermore, consider the legal implications being in a traffic accident. Is there no-fault insurance? Does a police officer have to be present at the scene of the accident? Were you a witness to an accident? Can you be sued? These are questions that consulate or embassy officials can answer.

Tips for road safety during travel
The golden rule is to use common sense. Being constantly alert to your surroundings and actively engaging in safe road practices will reduce the risk of an accident.

Pre-travel prep

• Learn the road safety rules of your destination.
• Research reputable bus and taxi companies, including motorcycle, scooter, and bike rentals with good safety and maintenance records.
• Rent a car from a reputable company. Read the fine print and learn about the possible implications of not getting insurance and adding additional drivers to your contract.
• Find the name of a reputable doctor or hospital. Don't forget to register with your consulate or embassy for legal help in case of an accident.
• Consider getting travel health and evacuation insurance. You may already be covered through your credit card or employee benefits. Read the policy and fine print to ensure that you're fully covered.

Pedestrians

• Look to your left and your right, and be aware of traffic patterns before crossing the street.
• Respect pedestrian traffic signs. Even if it seems safe to cross, a speeding vehicle or a fall will endanger you. Avoid jaywalking.
• Be alert at intersections and watch for erratic drivers. Hearing traffic is also important for your safety. Avoid using earbuds to listen to music or podcasts while walking.

Taxis and buses

• Get only into marked taxis and sit in the back seat. Use a seat belt and make sure all passengers buckle up with seat belts in proper working condition.
• Avoid driving in overcrowded, top-heavy buses.
• Also avoid getting into a bus whose driver is agitated, seems overtired or under the influence.
• If you feel unsafe, tell the driver to stop and get out. You can usually get a sense of their driving in the first few minutes of the trip.

Cars

• Buckle up! Always use a seat belt and ensure that all passengers use it. Do not get into a vehicle that does not have functioning seat belts for all passengers.
• Check tire pressure, treads, brakes, headlights, and wipers.
• Avoid driving at night. Rearrange your schedule so that driving occurs during the day.
• Do not use mobile devices while driving. While you may want to take a hands-free device along, this is not recommended if you're unfamiliar with the roads. Some countries, Portugal for example, have banned hands-free talking devices.
• Do not drink or consume drugs (even small amounts) prior to driving. Some countries, such as Saudi Arabia, Singapore, have zero tolerance.

Motorcycles, mopeds, scooters, bicycles, and rickshaws

• Always wear a helmet, even if it's not required by law. Make sure it fits properly and that the protection standards are up-to-date. The best option is to bring one with you from home.
• Use a reflective vest or tape, wear bright clothes.
• If you do not have experience driving these types of vehicles, do not learn abroad.
• Avoid driving and cycling on wet surfaces and at night.
• Avoid riding motorcycle / moped taxis or rickshaws.

Children

• Tell your child about the road safety rules of your destination.
• Always cross the road holding their hand.
• Rent a child car seat from a reputable company. If you bring your own from home, make sure that it's compatible in the cars you will be using at your destination (ie. can be properly secured).

Below are links to country Road Travel Reports and general information on road safety abroad:

• Association for Safe International Road Travel
• Make Roads Safe
• United Nations Decade of Action for Road Safety 2011-2020

Earlier this month, IAMAT's President M. Assunta Uffer-Marcolongo was invited to Beijing for the launch of the Chinese edition of The Travel and Tropical Medicine Manual, 4th Edition edited by two key IAMAT supporters, Dr. Elaine Jong and Dr. Christopher Sanford.

The translation of this textbook is a significant milestone for travel medicine in China. As one of the most popular travel destinations, Chinese travel health providers see thousands of international travellers every year, including Chinese travellers going abroad and returning expatriates. This learning tool – now available in their own language – helps practitioners to further implement internationally recognized travel medicine best practices. It also fosters opportunities for the advancement of travel medicine's knowledge base, training, practice, and research benefitting all travellers. The launch, which took place on September 19, was attended by doctors from local IAMAT affiliated clinics.

From left to right: Chen Xiao Feng, Ge Zhirong, M. Assunta Uffer-Marcolongo, Wei Chuan Zhong, Victor Lam, and Wang Feng Ting.

Also present were Wei Chuan Zhong, AQSIQ Vice Minister; Chen Xiao Feng, AQSIQ Director of Health Quarantine; Ge Zhirong, CIQA President; Victor Lam, Chief Representative of Elsevier publishing in China; Wang Feng Ting, Vice Director of Beijing University Medical Press; Dr. Liu Zy and his colleagues at CITHA; Dr. Zhang Min, the translation co-ordinator; as well as staff from the AQSIQ Health Quarantine and International Cooperation Departments. *See below for a list of the organization abbreviations.

Below is the Forward in the Chinese edition of The Travel and Tropical Medicine Manual:

The new Chinese translation of The Travel and Tropical Medicine Manual, Edition 4 (TTMM4), is dedicated to Mrs. Assunta Marcolongo, President of the International Association for Medical Assistance to Travellers (IAMAT), with headquarters in Guelph, Canada. Over the past two decades, Mrs. Marcolongo has worked with Chinese colleagues to develop educational programs and educational exchanges in order to increase knowledge and awareness of travel medicine in China among physicians and other health care workers. Possessing a deep interest in Chinese history and culture, she has traveled extensively in China since 1995 to conduct training sessions on the curriculum of international travel medicine, and to inspect Chinese travel medicine clinics wishing to join the IAMAT global network of English-speaking doctors committed to providing high quality medical services to travelers. Mrs. Marcolongo has been an inspiring advocate for quality improvement, and has become a treasured friend to many of the Chinese colleagues she has worked with. It is due to the encouragement and vision of Mrs. Marcolongo that the project to publish an official translation of the TTMM4 has been accomplished.

Dr. Elaine Jong, the senior editor of the TTMM4, met the late Dr. Vincenzo Marcolongo in the 1980's and discovered that they shared a passionate interest in the health of international travellers. Dr. Marcolongo read the first edition of the TTMM published in 1987, and gave Dr. Jong valuable comments on its content. Dr. Marcolongo was the founder of IAMAT in 1960, a non-profit organization dedicated to providing up-to-date health information directly to international travellers, to coordinating a global network of English-speaking doctors who agreed to provide excellent care to travellers, and to developing education programs on travel medicine for health care professionals. Dr. Marcolongo invited Dr. Jong to join IAMAT's Medical Advisory Board.

Following Dr. Marcolongo's premature death in 1988, Assunta Marcolongo became President of IAMAT, and Dr. Jong became Chairman of the IAMAT Medical Advisory Board, and they have collaborated in many ways to fulfill the educational mission of IAMAT since that time. Dr. Marcolongo had believed that it was important for physicians caring for international travellers to become familiar with the clinical practices and medications used in the traveller's country of origin. For some physicians working in countries serving as popular travel destinations for Western travellers, this meant that some of their medical training should take place in an English-speaking educational environment. In 1995, Mrs. Marcolongo and Dr. Jong began to work with Chinese colleagues to promote travel medicine education in China, and beginning in 2002, IAMAT developed a pilot program for short-term clinical travel medicine education of Chinese medical scholars at the University of Washington, Seattle, USA, where Dr. Jong was on the medical faculty. Just a decade later, IAMAT is proud that a growing number of Chinese travel medicine physicians have taken the International Society of Travel Medicine (ISTM) Certificate of Knowledge Examination and have been awarded the Certificate in Travel Health (CTH), recognized as a standard of excellence throughout the world.

Dr. Elaine C. Jong
Chair, IAMAT International Medical Advisory Board
Clinical Professor (Emeritus) of Medicine, University of Washington
Consultant in Traveller's Health and Clinical Tropical Medicine

*List of Organization Abbreviations:
AQSIQ = General Administration of Quality Supervision, Inspection and Quarantine
CIQA = China Inspection and Quarantine Association
CITHA = China International Travel Healthcare Association

We often get asked how to mitigate the health effects of air pollution during travel. Outdoor air pollution (a toxic soup of chemicals, particulate matter, and biological materials that react with each other) is a major public health issue, contributing to chronic diseases, increased hospitalization, and premature mortality. In fact, the World Health Organization estimates that air pollution causes 2 million premature deaths worlwide every year.

What are the symptoms of air pollution?
The short-term symptoms of exposure to air pollution include itchy eyes, nose, and throat, wheezing, coughing, shortness of breath, chest pain, headaches, nausea, and upper respiratory infections (bronchitis and pneumonia). It also exacerbates asthma and emphysema. Long-term effects include lung cancer, cardiovascular disease, chronic respiratory illness, and developing allergies. Air pollution is also associated with heart attacks and strokes.

Some of the culprits causing air pollution include:
Carbon monoxide (CO) - reduces oxygen from reaching organs and tissues. Exposure to high levels also affect mental alertness and vision.
Ozone (O₃) - is not the protective layer in the Earth's upper atmosphere, but the 'bad' one near ground level which forms as a result of toxic chemicals reacting with sunlight. This type of ozone irritates the respiratory system and can inflame and damage the lungs' lining. Long-term exposure results in diminished pulmonary function due to scarred tissue and an increase in respiratory infections.
Sulfur dioxide (SO₂) - constricts your airways and in the long-term can diminish the lungs' defence mechanisms.
Nitrogen oxide (NO₂) - causes inflammation of the respiratory system, reduces immunity to respiratory infections, and aggravates asthma and bronchitis.
Particulate Matter (PM) - causes significant damage especially to people suffering from chronic heart and lung disease who are at higher risk of premature death. Depending on the size of the inhaled particles, they deposit in the lungs and cardiovascular system migrating to other organs including the brain, ultimately affecting body functions.

Planning your trip
We often hear about large cities having the worst air pollution records; Hong Kong, Delhi, Manila, Cairo, Mexico City, and Santiago come to mind. However, smog also affects rural areas depending on weather patterns, geographic landscape, and whether polluting industries such as smelting, refineries, mining, and heavy manufacturing are nearby.

No matter your destination, you will not be able to escape air pollution, but the length of exposure and concentration of pollutants will have an impact on your health during travel.

When planning your trip, consider these five factors to help you mitigate the effects of air pollution.

• Health Status: What is your current health status? Do you have asthma, allergies, chronic bronchitis, heart or lung disease?
  
• Age: Are you an elderly person or travelling with young children. The elderly are more susceptible to air pollution due to pre-existing chronic conditions and newborns and children take in more air (higher level of pollutants) than adults for their body weight.
  
• Destination: Are you going to an urban area, a city in a valley, or where rain is uncommon?
  
• Length of Trip: Are you going for a short or long-term trip?
  
• Season: What time of year are you going? Depending on seasonal weather patterns, smog tends to occur during hot and humid days. If you suffer from asthma or allergies, also consider the occurrence of pollen season at your destination.

Quick tips for travellers
Studies from around the world on the health impacts of low air quality are done on long-term residents. However, according to Dr. Chris Sanford, an expert on urban travel medicine, we can extrapolate information for travellers, but the full extent of travel health risks is still unknown.

1. While it may not fit your itinerary, heed warnings to stay indoors during high smog alert days. Ask around and observe what locals are doing. Before you leave for your trip, find out where you can access local air quality alerts (ie. Newspapers, television, radio, or online).
2. Avoid strenuous or extreme physical activity. Even if you are very healthy, low air quality can impact your health and may have long-term consequences.
3. Seek immediate medical attention if you have trouble breathing or chest pain.
4. If you have asthma: Minimize exposure and travel with an inhaler or an oral steroid (consult your doctor to see what is best for you).
5. If you suffer from Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema: In addition to your usual medications carry an inhaler, antibiotic, and oral steroid (consult your doctor to see what is best for you).
6. If you have a history of cardiac or pulmonary disease: Ensure that your condition is under control before departure. You may want to reduce the duration of your stay in an area with high air pollution.
7. For older travellers, get a physical exam that includes a stress and lung capacity test prior to departure.
8. If you are travelling with newborns or young children, minimize exposure or consider not travelling to areas with low air quality.
9. Depending on your destination, find out from your doctor if a breathing mask is a good option for you.

How to find out about air quality at your destination?
Countries and regional blocs (ie. European Union) have different measurement standards and indexes to communicate air pollution levels. Generally however, indexes show scales from good to hazardous air quality along with advice for sensitive population groups.

There isn't one source that publishes a comprehensive list of air quality conditions around the world. However, AIRNow and Arthur Zbygniew's Blog have good links to local air quality indexes around the world. Please note that some links don't work and that IAMAT does not necessarily endorse the views found on external websites.

UPDATE: In September 2011, the World Health Organization published a comprehensive database of outdoor air pollution risk around the world, including interactive maps. See WHO Exposure to Outdoor Air Pollution.

Our Medical Directory is growing!

We're very pleased to welcome two new doctors to our international network. IAMAT Members now have access to a mental health professional in Caracas, Venezuela and a general practitioner in Port Perry, Canada. To see our two recent additions, go to: Medical Directory.

One of our main functions is to find highly qualified doctors committed to helping you in case you get sick abroad. We constantly update our Medical Directory with new information and publish a hard copy edition annually. IAMAT regularly inspects and reviews affiliated clinics based on international health standards. Our physicians and mental health practitioners volunteer to be part of IAMAT; they do not pay a membership fee to join, allowing us to maintain strict ethical standards.

For more information, go to: Medical Directory program. You may also want to find out more about our Travel Medicine training program.

Wishing you a wonderful summer season from all of us at IAMAT.