International Association For Medical Assistance to Travellers

2012 IAMAT Survey Results

Earlier this year, we asked you about your travel destinations and travel health needs so that we can serve you better. Below are some of the result highlights from the 2012 IAMAT Survey based on 1517 responses.

Congratulations to survey respondents, Letty Ann Macdonald of Barboursville, Dave Smith of Sacramento, and Judy Stralka of Mill Valley, who won gift certificates from Mountain Equipment Co-op, Magellan's, and TravelSmith!

Top Travel Destinations

In the last three years members travelled to the following geographical regions...

Top 5 travel health concerns of IAMAT members

  1. Immunization needs and requirements
  2. Infectious diseases
  3. Food and water safety abroad
  4. Access to doctors who speak your language
  5. How to travel well with chronic illnesses

55% would like to get more advice on how to navigate travel medical insurance

IAMAT DOCTORS

In the last 3 years, members needed to consult an IAMAT doctor for...

  1. Acute conditions like fractures, burns, allergies...
  2. Gastrointestinal illnesses
  3. Prescription refills

Places where members visited an IAMAT doctor in the last 3 years

Overall satisfaction with medical care provided by IAMAT doctors 85%

MEMBERSHIP

Top reasons why travellers join IAMAT:

Our travel health advice and access to reputable doctors abroad

You've been an IAMAT member since...

You heard about us primarily through

  • Word of mouth
  • Internet search
  • Healthcare professional

Thank you!

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!

Travel and Tropical Medicine Book Launch in China

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

What are the Health Effects of Air Pollution During Travel?

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.

Energizing Our Future with a Solar Park

On May 24, we had the pleasure of announcing the creation of a solar park to help IAMAT advance its mission.

The Foundation for the Support of International Medical Training (FSIMT), the entity governing IAMAT, owns a 105-acre property in Guelph, Ontario, Canada. The Foundation recently entered into a Lease arrangement with Hall's Pond Solar Co-operative for the purpose of developing a solar photovoltaic park.


IAMAT's President, Assunta Uffer-Marcolongo announcing the largest community financed urban solar park in Ontario.

Example of solar panel modules.

The Foundation's Board of Directors believes that the solar park Lease is an excellent opportunity for IAMAT to advance its mission and grow its endowment fund for doctors and nurses from low resource countries to study and train in travel medicine. The solar park also honours IAMAT's Founder, the late Dr. Vincenzo Marcolongo's fondness for the property and his desire to protect its unique ecological and heritage features.

The planned 7.5 megawatt ground-mounted installation will be located on part of the Foundation's urban reserve lands. It will be the largest urban community financed solar project in the province of Ontario and an important contribution to the City of Guelph's Community Energy Initiative. The solar park will be developed by Options for Green Energy, a division of Options for Homes, a non-profit corporation that assists in the development process. The project is supported by the Guelph's Mayor, Karen Farbridge - who also presented at the press conference last week - and the Guelph Chamber of Commerce.

We recognize the invaluable work of volunteer community members Bruce Bocking, Mike Fortin, Jaya James, Stan Kozak, Dan Pestill, and Jeremy Shute for their expertise and advice to the Foundation.

For more information about the project:
  • Hall's Pond Solar Co-operative
  • Big urban solar park planned for south end
  • New solar projects warming up
  • Energy Park to set city as leader in community

    Photos courtesy of Options for Homes.

  • Bed Bugs and Travel: Don't Let Them Get To You

    UPDATE: In May 2011, Canadian researchers found bed bugs with Methicillin-resistant Staphylococcus aureus (MRSA), bacteria that is highly resistant to antibiotics and can cause infection in people with compromised or weak immune systems. See their findings at Bed Bugs as Vectors for Drug-Resistant Bacteria.

    Many of us consider "Night, night, sleep tight, don't let the bed bugs bite" a quaint nursery rhyme no longer applicable in the 21st century. Not so. Bed bugs are making a major comeback in part due to increasing international travel and resistance to pesticides.

    So far, there is no evidence that bed bugs transmit infectious diseases. However, coming into contact with these pesky insects during your trip will cause physical discomfort and psychological stress. Getting rid of bed bugs will take time and undoubtedly test your stress coping abilities. In fact, persons suffering through a bed bug infestation commonly have symptoms of anxiety and depression.

    Bed bugs don't fly, but are very quick and squeeze easily into cracks and crevices. Both male and female bite at night, feeding on human blood. They live for about one year, but they can survive without feeding up to 6 months, sometimes longer.

    During the feeding, the bed bug injects saliva causing skin irritation and inflammation. Scratching the bite area causes a rash, and can progress to swelling and red welts on your arms, legs, face, and chest area. Try not to scratch and keep the skin clean to prevent infection. Calamine lotion helps relieve the itchiness. Talk to your doctor about getting a prescription for antihistamines for relief as well.

    How to recognize a bed bug
    Since bed bugs are nocturnal, you most likely won't see them. However, their eggs and feces betray them. Look for clusters of feces (black / brownish dots) and eggs (whitish, the size of a pinhead, in clusters of 10-50).

    An adult bed bug has a brownish pear shaped body and typically measures ¼ inch or 1.9cm long. What is fascinating is that its body can change dramatically: Before feeding a bed bug can be as thin as paper, but after feeding it becomes bloated.

    Travel and Bed Bugs
    Bed bug on a person's hand.
    Travel and Bed Bugs
    Bed bug on a tweezer.

    Preventing bed bugs from hitching a ride
    Before Your Trip
    1. Learn about bed bugs and their behaviour. Bedbugger.com has photos and a wealth of information about the insects.

    2. Consult The Bed Bug Registry or Trip Advisor to see if other travellers have reported suspected bed bug infestations where you will be staying. Keep in mind though, that these reviews may not be reliable since they are not corroborated by an independent third party.

    3. Bring clear or opaque plastic bags that can be properly sealed for worn clothing / laundry and to wrap your luggage. You can find extra large plastic bags at your hardware store.

    4. You may want to bring a permethrin-treated bed net. Bed net protection will not work if the mattress is infested with bed bugs.

    During Your Trip
    1. Inspect your room. Check for feces and eggs in the following: Mattress and box spring seams, creases, and folds Headboard, cushions Side table drawers, chairs, furniture Picture frames, radios, TVs, phones, clocks Baseboards, window and door casings, cracks and crevices

    2. Don't unpack your clothes from your suitcase. Place your luggage in the bathtub or shower stall. If there is no washroom adjacent to your room, place your luggage in a large clear plastic bag and keep it away from the bed and the floor.

    3. Place all clothes for laundry (including your pajamas) in a tightly sealed plastic bag to contain potentially affected clothing. To avoid escaping bed bugs back home, sort laundry in colours and place in separate plastic bags so it's easy to load the washing machine.

    When You Return
    1. Place your luggage in an isolated part of the house, such as your garage or porch. Thoroughly inspect the suitcase and all articles of clothing that are not sealed in a plastic bag.

    2. Wash your clothes using the hottest machine setting (washing at high temperatures will kill the eggs). Some fabrics will not be able to withstand hot water, so dry-cleaning may be an option. Don't forget to warn the dry cleaner about a possible bed bug problem.

    3. Dry your clothes at the hottest setting for at least 45 minutes.

    4. For suitcases and larger items that cannot be put in the washer or dryer, you can wash them with hot water (at least 37.7°C – 48.8°C or 100°F – 120°F). Use a scrub brush for the seams.

    5. Items that can't be washed can be heated or frozen. If using extreme heat, the item has to be exposed to a minimum of 45°C or 113°F for at least two hours. If you freeze the item, it should be at a minimum of -5°C or 23°F for at least 5 days or can be flash frozen at -26°C or -14.8°F. For more information, the University of Minnesota has useful guidelines.

    If you suspect that you brought back bed bugs with you, contact a pest control company for a consultation. They will have tips on how to get rid of them and suggest a treatment schedule. There are a variety of options out there (but also a lot of misinformation) on both toxic and non-toxic extermination methods. Talk to a professional or a person who has successfully stopped bed bug infestations at home. Resources are out there – the key is to be consistent and thorough.

    Photo Credit: Centers for Disease Control and Prevention, 'Bed Bug Infestations in an Urban Environment.'

    Spotlight on South Africa

    Counting down the days to the start of the Soccer World Cup tournament? This year it's being held in South Africa from June 11 to July 11. It's one of the few events that brings out extreme emotions among fans, and like other world sporting events, this tournament will bring attention to the country's natural beauty, history, and cultures.

    Travellers are asking us about our recommendations on how to stay healthy in South Africa. In case you need to see a doctor, you'll find that healthcare standards in the country vary between large urban centres and remote areas. High quality care is the norm in cities while in rural areas medical care tends to be basic.

    IAMAT doctors are located in five World Cup host cities (Cape Town, Johannesburg, Bloemfontein, Port Elizabeth, and Pretoria) in addition to George, Knysna, Secunda, and Stellenbosch. Our doctors charge a set fee for the first consultation and will refer you to a specialist if needed.

    As you're getting ready for your trip, you'll find advice and tips on health from many sources, often incomplete or unreliable. IAMAT relies on local medical contacts for its health recommendations, including guidelines set by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Here's what we suggest for South Africa:

    Routine Immunizations - Tetanus-Diphtheria, Poliomyelitis, Measles, Mumps, Rubella should be reviewed and updated if necessary. There is currently a measles outbreak in the provinces of Western Cape (Cape Town being the epicentre) and Eastern Cape (Libode region). We recently blogged about Measles and how to protect yourself.

    Seasonal influenza – If you are 50 years or older or are immuno-suppressed ask your doctor or travel health clinic about getting anti-viral medication. Right now flu season is getting underway in the southern hemisphere.

    If you are planning a trip to remote areas, planning extensive hiking or trekking, or going on a safari, we recommend getting vaccinated against Hepatitis A and Typhoid Fever.

    Malaria medication is required if you are going to Northeastern provinces of Limpopo, the low altitude areas of Mpumalanga and KwaZulu-Natal as far south along the coast to the Tugela River, including Kruger National Park.

    Risk of malaria occurs throughout the year and the incidence of P. falciparum malaria (the deadly form) is at 90 percent. Some anti-malaria drugs are resistant so based on your health status and type of trip, see our Malaria Suppressive Medication Guidelines (click on Disease Risks).

    Schistosomiasis (also known as Bilharzia) is present in South Africa. This disease is transmitted by snails living in fresh water such as lakes, rivers, streams and ponds. Avoid swimming in fresh water even if you are extremely tempted! Read about the geographical distribution of this infection and the rules to prevent illness.

    Keep in mind that HIV is endemic in South Africa. To prevent HIV and other sexually transmitted infections, avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home. There are no HIV entry or long-term stay restrictions for South Africa. Check out The Global Database on HIV-Specific & Residence Restrictions for the latest information and a list of resources.

    For your safety, it is recommended that you do not leave well travelled tourist areas without a trusted guide. Never walk alone after dark and avoid secluded areas. Theft is a concern for travellers. Consult your government's travel information website (ie. Foreign Affairs – Canada and US Department of State - International Travel) for their recommendations on safety and security.

    For a complete list of potential health risks and how to prevent them, see our South Africa country profile.

    Travel Writing Workshop: Sept 15-19

    After taking a short summer break, the IAMAT Blog is back! Many of us are winding down our summer travels and holidays, getting ready for the back to work and back to school season. For us at IAMAT, it's usually a time to take stock of the coming year, start new projects - a new beginning of sorts.

    If you are considering taking up a new challenge this Fall and have always dreamed of combining your travel experience, creativity, and passion to discover new things and meet new people, there's an affordable workshop for you. Robert Haru Fisher, a columnist and contributing editor for frommers.com (and a member of IAMAT's Board of Directors), is offering his popular Travel Writing Workshop in the beautiful Upper Hudson Valley, NY in September.

    The theme of this intensive three day workshop is 'How to shape your writing and then market it successfully.' Robert will guide you through the different types of travel writing, good writing styles, research techniques, getting published in electronic and traditional media, and networking. Students will also participate in reading and group discussions / critiques of writing assignments. The workshop includes a tour of the Upper Hudson Valley area with writing assignments to be done in the evening. A fourth day, which is optional, was added for participants interested in having one-on-one interviews with Robert.

    Here are the details:

    • Date: September 15-19, 2009 (optional evening reception on September 15).
    • Location: Space 360 in Hudson, NY (approximately 2 hours from New York City).
    • Cost: US $275

    For more information (includes information on local accommodations) and to register go to: Travel Writing Workshop

    To learn more about Robert's work go to: BobHaru.com and Mad Travel Writer Blog.

    Welcome to the IAMAT Blog!

    We are very pleased to announce the re-launch of our website.

    Our new site better reflects our work and we hope that you will find all the information you need to make your trip a safe and healthy one.

    Exciting new features will allow you to:

    • Get instant membership in your inbox - IAMAT membership is free.
    • Get a tax deductible receipt (US and Canada) in your inbox for your donation to IAMAT - any amount is appreciated.
    • Access all the travel health advice you need, including vaccinations, disease risks, and food and water safety advice for your destination.
    • Easily access our popular Medical Directory using your IAMAT membership number to find qualified IAMAT affiliated doctors at your destination.
    • Take us with you! Plan your trip with our Travel Health Planner and generate a personalized guide to our medical services and travel health advice for all your destinations. Print a copy, save for future online viewing, or access with your mobile.
    • Sign up to our Blog and get helpful updates and tips related to your health and international travel.
    • Receive our quarterly e-Newsletter (with membership sign up) highlighting our programs, projects, and key developments in travel health and medicine.

    Thanks to Snap Design and Blaeberry Solutions for their invaluable expertise and making this project a reality.

    Please have a look and let us know what you think. We appreciate your feedback!

    IAMAT Staff