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.

The recent illnesses and deaths caused by the E.coli outbreak in Europe, remind us of the complexities of food systems and that you don't have to travel to get sick: Food- and water-borne illnesses happen in our own backyard.

Gastro-intestinal infections can happen in any country. Getting food to your plate involves a variety of players including growers, transportation companies, processors, retailers, food handlers, consumers, and government regulations. While food coming from a local source may get to your table faster than food grown far away, both conventionally and organically grown products are susceptible to carrying pathogens like E. coli and salmonella. Unsanitary farming conditions, poor food processing and handling practices, lack of food and import surveillance inspectors, and non-transparent self-regulated food processing companies are some of the culprits that have made people sick. In Canada, for example, health experts believe that approximately 38% of the population gets a food-borne illness every year.

Why Do We Get Sick With E.coli?
E. coli, also known as Escherichia coli, is a bacteria that naturally resides in our gasto-intestinal system. There are multiple strains of E. coli, but the harmful ones (of which E. coli [O104:H4] was responsible for the outbreak in Germany and France) produce toxins that can be lethal to humans.

Travel increases the chance of getting sick partly due to the physical and psychological stress of being in a different place. Your immune system tends to get weaker. Add to the mix, the difficulty of choosing safe food since we usually don't know the source or the trajectory it took to get to your plate.

How To Avoid Food and Water Illnesses
It's so tempting to buy food from a street vendor selling noodle soup or fresh fruit when you've been sightseeing the whole day or are invited to a restaurant to try the local delicacy – raw seafood. You remind yourself that part of the travel adventure is trying what the locals eat. Yet, you've heard the stories of friends, or even you have one, where most of the trip was spent in a bathroom or in bed.

Here are 3 simple steps to ensure that you don't get sick away from home:

1. Wash your hands thoroughly!
Simple hand hygiene is a proven method to reduce the spread of bacteria and viral infections. Wash with soap and water for at least two minutes before eating, after using the toilet, touching publicly used surfaces such as door handles, hand rails, elevator buttons, and currency, or if they're dirty. If you don't have access to soap and water, an alcohol-based hand sanitizer is an alternative.

2. Repeat and practice the mantra: BOIL IT, COOK IT, PEEL IT, OR FORGET IT.
Easy to say, but hard to do sometimes due to lack of convenience. At all times though, make sure you only eat well cooked foods or fruits that you can peel. Stay away from shellfish, eggs, meat, and dairy products that have been out for a long time. Also avoid unpasteurized products, including milk, cheese, ice cream, juice, and cider.

3. Drink purified water.
The best is boiling your water since it destroys bacteria like E. coli. Keep it at a roiling boil for 10 minutes. Hotel rooms usually have a kettle in each room. If not, ask for one so that you can boil the water and cool it overnight to pour into your water bottle before heading out for the day. Water bottles are also an option, but there are environmental implications and it may be outdated or tampered with. If you are going to drink bottled water, make sure that the cap is properly sealed and check the best before date. If you are going to remote areas, choose a water filter best suited for your type of travel, or bring along iodine or chlorine tablets. Follow purification instructions properly.

E. Coli Infection Symptoms
Symptoms of E.coli infection usually start appearing within hours, but sometimes it can take up to 10 days to approximately one month to show up. Food poisoning symptoms may include sharp stomach cramps, nausea, vomiting, diarrhea, and fever. In severe cases, patients will have bloody diarrhea, low red blood cell counts (hemolytic uremic syndrome), low platelet counts (thrombocytopenia), and kidney failure. Children, pregnant women, the elderly, and persons with compromised immune systems are at higher risk of developing complications. Some people however, never develop symptoms but are E. coli carriers and spread the infection unknowingly.

If you suspect E. coli infection or food poisoning, seek immediate medical attention. It's important to drink lots of fluids to prevent dehydration – water is best if you have access to a clean source.

IAMAT's travel health information includes food and safety information for all countries. See also our 24 World Climate and Food Safety Charts.

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.

As a record number of travellers are booking cruise holidays – the latest numbers show that there were approximately 15 million cruise passengers worldwide in 2010 – the risk of getting ill on a cruise ship increases.

Illnesses on large ships have a ripple effect; living in close quarters with hundreds or thousands of other travellers for an extended period of time not only exposes you to infectious diseases, but can also have a negative health impact on host port communities where passengers disembark for sightseeing tours and on-land activities.

What are common illnesses found on cruise ships?
Gastro-intestinal illnesses (gastroenteritis) caused by norovirus, e. coli, and salmonella can be present on cruise ships. These highly contagious viral and bacterial infections are transmitted by:

- Ingesting contaminated food and fluids
- Improper hand and body hygiene (fecal-oral route)
- Touching infected surfaces and objects
- Coming into close contact with a sick person

Symptoms usually develop within 12 to 48 hours after exposure and can appear suddenly. They include vomiting, watery diarrhea, abdominal cramps, fever, headache, and nausea. The illness typically lasts 1 to 2 days, but you can be contagious anywhere from 3 days to 2 weeks after getting sick.

Respiratory illnesses such as influenza are also common on ships. The virus is transmitted among passengers through infected air droplets by sneezing or coughing. A person can be contagious 1 day before and up to 7 days after symptoms appear. Symptoms include high fever, sore throat, nasal congestion, high fever, muscle aches, headache, fatigue, and general weakness. Patients usually recover after 1 or 2 weeks, but the illness can cause complications in young children or persons with pre-existing health problems.

The hepatitis A virus is transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Hepatitis A symptoms can mimic the flu - fatigue, nausea, abdominal pain, fever, loss of appetite, and jaundice (skin and eyes). Symptoms appear anywhere from 2 to 6 weeks after being exposed. The illness can last up to 6 months. However, some people are long-term hepatitis A carriers and will not exhibit any symptoms during their lifetime.

Legionnaire's Disease is a lung infection caused by the Legionella bacteria. Passengers acquire the infection when breathing contaminated air droplets from water found in hot tubs, hot water tanks, building air conditioner and plumbing systems that are not properly cleaned and disinfected. Symptoms mimic pneumonia (cough, chills, high fever, muscle aches and headache) and usually appear 2 to 14 days after being exposed. If caught and treated early with antibiotics, patients can make a full recovery, however it is responsible for fatalities in up to 5% - 30% of cases. The bacteria does not spread from person to person.

Due to the different immunity status of passengers and being in a confined area, persons who are not vaccinated are also at higher risk of contracting vaccine preventable diseases.

What should I do before my trip?
1.Consult with your doctor to make sure your routine immunizations are up-to-date. We also recommend getting the hepatitis A and B vaccine.
2.If you have any chronic illnesses such as diabetes, heart disease, or a compromised immune system, ask your health practitioner if taking a cruise holiday is right for you. You may want to consider specialty cruises for passengers with chronic illnesses and disabilities.
3.If you are sick before your trip, advise the cruise company to see if there are alternatives or if you can postpone the trip. You don't want to be responsible for making other passengers sick.
4.Research your cruise line's reputation. Tour companies are required to report any illnesses and evaluations are publicly available through government websites. If the ship reported illnesses in the past, find out how they dealt with it and what measures they have taken since to prevent the spread of infectious diseases.
5.Check if your cruise trip is covered by your travel health insurance.

How do I protect myself and others?
1.Wash your hands often and thoroughly. We cannot emphasize this enough! Good hand hygiene is proven to reduce illness and the spread of infectious diseases. Wash your hands with soap and water for at least two minutes before eating, after using the toilet, touching publicly used surfaces such as door handles, hand rails, elevator buttons, and currency, or if they're dirty. Also remembers to keep your hands away from your mouth and face. If you don't have access to soap and water, an alcohol-based hand sanitizer is an alternative.
2.Stay healthy and hydrated. Drink lots of water, eat healthy foods, and get regular sleep. Check out your cruise ship's exercise room and wellness schedule. Book an aerobics, pilates or yoga class. Maintaining a healthy immune system and good mental health will decrease the risk of getting ill during travel.
3.Boil it, cook it, peel it, or forget it should be your mantra when travelling. Many cruise lines have a good reputation when it comes to food preparation and handling. However, when you get off the ship make sure to eat well cooked foods or fruits that you can peel. Avoid shellfish, meat, and dairy products that have been out for a long time.
4.Practice safe sex.

What to do if I or others around me get sick?
1.If you get sick, immediately report your illness to the cruise's medical staff. They will tell you what precautions you should take to improve your health and prevent further infection.
2.If someone gets sick in your vicinity (such as vomiting or diarrhea), leave the area and notify medical staff.
3.Avoid shaking hands or being in close contact with other passengers. Make sure to wash your hands frequently.
4.Stay well hydrated.

For more information on ship health go to:
Health Canada Cruise Ship Inspection Program
CDC Vessel Sanitation Program