Why Your Brain Tells You to Worry About Ebola

And Which Virus You Really Should Worry About.

Brain Worry

Alexa came in a few days ago with classic symptoms: first the headache, followed by a fever of 102, and then muscle aches; she felt terrible. In fact, it was the worst she’s felt in her life.

So with all that’s in the news lately she couldn’t help but ask,

“Could this be… Ebola?”

And so the questioning begins. “I have a trip to New York City next week, is it safe to fly? Is it safe to go out in public?”

All the while I was thinking in my head,

“Are you kidding me?? Of course it’s not Ebola. You haven’t been to West Africa, no one you know has been to West Africa. In fact, you haven’t even left the suburbs of Pittsburgh! Of course it’s NOT Ebola….Don’t you know we’re having an outbreak of the flu. That’s what you have! And why didn’t you get your flu shot??”

But of course, I didn’t say that, it wouldn’t have helped.

I am really frustrated that you, my patients, are spending a lot of time worrying about rare diseases, all the while missing opportunities to protect yourselves from common viral illnesses. Especially ones that can kill you.

Yes, KILL you.

But it’s really not your fault. Your brain is miscalculating your odds of impending doom.

It’s so hard to communicate real risk vs. perceived risk. What does that mean anyway?

Our brains are hard-wired to pay attention to new things and to be cautious about things we don’t know much about. Usually this is a good idea, since unfamiliar things can hurt us, so it’s best to stay on your toes.

However, this increased attention to unfamiliar threats can also be a problem. We can focus too much attention on something new, but rare, and forget to worry about what really matters–things that are common and dangerous.

You’ll often extrapolate what you know from your own experiences to the unknown but make incorrect assumptions about that unknown situation.

That is, we make a poor estimate of the true risk of the new/unknown thing based on what’s happened in the past. This causes us to over-estimate or under-estimate the likelihood that the new problem will harm us.

That’s exactly what is happening with Ebola and the relentless media attention it’s getting.

We’re spending a lot of time worrying about something that isn’t a real threat to people living in the USA, and not enough time worrying on things that do affect our health and safety.

We humans are funny. We can even understand that we’re at risk for a bad outcome but won’t actually do anything about it. How we perceive dangers and what we want done about the dangers is an area of active research

I see this on a daily basis with influenza.

  • When offered the flu vaccine most people accept either the injection or inhaled variety. However, quite a few choose not to get protected, even though it’s hands down the best value in medicine. For around $25 you can protect yourself from a virus that’s readily spread through the air, kills perfectly healthy people  and is easily prevented by annual immunization.
  • Infection with influenza is quite common and deadly. I know this all too well. A young, healthy woman in our town died last year from influenza. Flu infects between 5-20% of the population and kills between 3,000 and 49,000 people each year in the USA. In fact 55 perfectly healthy children died from influenza last season.
  • So prevention would help a lot of people and save a lot of lives.
  • Compare Influenza to Ebola and it becomes clear our real risk from death from a viral infection in the USA is from influenza. To date, nine people have been infected with Ebola, but only two contracted the illness inside the USA (while caring for a patient sick with Ebola). One person has died of Ebola he contracted in Liberia.

Why are we so worried about Ebola? By the numbers, we should be worrying about Influenza, but our hard wiring tells us to pay attention to Ebola. It’s weird, but that’s the way our brains works.

Now it’s time to get a grip, overcome our basic instincts and conduct our lives as usual.

That still leaves our brains with a big question: What should we do about Ebola?

  • Learn the facts
  • Feel free to travel in the USA since you cannot catch Ebola through casual contact.
  • Stop calling for closing the borders, that’s not how you stop the spread of germs.
  • Provide substantial assistance to the three countries most severely affected. (That is how you prevent the spread of germs.)
  • Let the experts in health and safety at the CDC and WHO do their job. They ‘re the best in the world at protecting us from infections. Don’t second-guess them just because your brain is worried about something you don’t understand.

Evaluate your real risk of Ebola… slim to none if you live in the USA.

If you want to worry about a viral illness, focus on influenza, and get protected with a vaccine. It’s easy; immunizations are effective and widely available.

 

I’d love to hear your thoughts on the matter. Leave a comment below:

Do you need shots for World Cup Soccer in Brazil?

Soccer

You are going to have a great time.  Let’s make sure you are also safe and healthy while you are having fun.

The first thing to do is to meet with a travel health specialist.

You may need shots to stay healthy at in Brazil. Your travel specialist will make sure your routine vaccines are up to date. Vaccine preventable illness is everywhere, but the variety increases when people gather from all over the world.  Tetanus, Pertussis, Influenza, and Measles are just a few on the list. Travel related vaccines to consider include Typhoid Fever and perhaps the most important one, Yellow Fever.

Your provider will also discuss malaria prevention, with risks varying greatly throughout the country. You may need preventive medications to be started before you leave home, especially if you are lucky enough to score tickets to the venue in Manaus. Insect precautions are discussed later in this article.

Food and water precautions and medication for treatment of traveler’s diarrhea are key. Food should be served piping hot. Eat only fresh fruits that you peeled yourself and vegetables which are cooked.  Dairy should be pasteurized. Bottled water, carbonated beverages, hot coffee and tea should be fine, but avoid tap water and ice cubes made with tap water.

What about the time zone difference?

Strategically using natural daylight and sleep aids can help with jet lag. Do your best to stay rested, but most of all, check your tickets and watch your game times because there are three time zones in Brazil!

I mentioned Yellow Fever vaccination above. Here is the scoop:

Yellow Fever is caused by a virus transmitted by a mosquito. It is bad.

Some cases are actually asymptomatic, but some are quickly and completely fatal.  Flulike symptoms begin 3-6 days after the bite and either resolve or progress toward abdominal pain, vomiting, hemorrhage, internal organ involvement, and possibly death.

It is called “Yellow Fever” because you literally turn yellow as the liver is damaged.

This is a big concern for travelers to certain parts of Brazil, especially World Cup visitors to the venue cities of Brasilia, Belo Horizonte, Porto Alegre, Cuiabá, and Manaus. Visitors to other World Cup venue cities may be OK without the vaccine, but expanded itineraries,   may change that.  A travel health specialist can help you research this as well as special precautions around receiving the Yellow Fever shot.

How to Prevent Insect Bites and the diseases they carry:

Here is the good news: If you aren’t bitten by an infected mosquito in the first place you won’t catch Yellow Fever. Or any other awful disease transmitted by mosquitoes, such as Dengue, Chikungunya, and Malaria.

So prevent bites. Long sleeved shirts and long pants, clothes treated with Permethrin, and for exposed skin, insect repellant containing DEET or Picardin make a huge difference. Layer repellant lotions and sprays on top of sunscreen, not underneath.

Personal safety while in large crowds.

“I should be OK once I am at the stadium. There is safety in numbers, right? “ Not these numbers!

Three million people will gather from all over the world to celebrate soccer. The thrill of attending the World Cup is being part of a cheering crowd. Much of the risk to your health and safety is found right there in that crowd.

Crime can be petty or violent. Leave your valuables in the hotel safe, or better yet, at home. Do not wear obvious symbols of wealth: expensive watches and jewelry. Protect your wallet and money. Don’t even think about using your pockets.

Sadly, we have all seen reports in the media of occasional riots and stampedes at such gatherings. Large groups of people who have lost their personal space (i.e, crowds) are naturally more inclined toward hostility. Combine this dynamic with alcohol, a favorite team’s loss, or someone saying something stupid. Add a few authentic hoodlums, throw in some panic, and you have the recipe for a riotous stampeding mob.  What can you do about that?

Be prepared. Stay really calm. Have a fully charged cell phone and a plan to reconnect with your group should you become separated. Wear shoes that make sense. Yes, sensible shoes! You will need good  balance and comfort.  You don’t want to be the one to trip and cause the pile up.

Arrive early and locate the First Aid station, exits, alternate exits, and shelter should the weather turn.

If you see a group of people gathering suddenly, resist the urge to move in for a good view. Move away. This could be a fight breaking out or a crime scene.

When the event ends, there will be a sudden exodus of people leaving the stadium. Most will be lovely. Some will be drunk. Some will be upset. Be careful here.

Moving crowds are like moving rivers, with the flow fastest in the center of the stream.  Stay toward the sides where the flow is slower and keep an eye out for potential exits or shelters should the crowd turn bad.  Never swim upstream.  Never stop suddenly.

If you want out, stay calm. Continue to move with the crowd as you slowly move laterally.

Also, however you plan to celebrate your team’s victory, no stage diving, crowd surfing, moshing, or Wall of Death. If you don’t know what these are, ask a teenager.

Know the weather forecast and dress in appropriate layers.  Some bring earplugs to use should the noise level become uncomfortable.

A few random tips:

Avoid natural bodies of fresh water in some areas of Brazil. There is a little larva, called Schistosomiasis, which can quietly and quickly pierce your skin and cause harm to your internal organs.

But if you choose to swim in salt water, check with the local authorities on the risks of certain potent jelly fish, currents, and other marine hazards.

Your best bet may be the chlorinated hotel pool!

And in case you are in serious trouble and need a medical evacuation home, your travel health insurance policy, wisely purchased before leaving home, will save the day.

Have a safe trip. Have a wonderful time! Come back healthy, but if you do get sick after returning home it is critical to tell your doctor about your itinerary.  Treatable travel related health issues, especially malaria, can surface long after you have unpacked.

 

Are you headed to the games? Which team do you cheer for? What worries you the most about your trip? Share your thoughts in the comments below:

Vaccines for Business Travel: Which Ones do You Need?

Booster Vaccines for TravelersWhy some business travelers get their vaccines before they know where they are going.

Jim was in the office asking questions, ” Are you kidding me?”

“Nope, how long have I known you Jim? If your new job promotion includes traveling abroad you need to get some vaccines. I suggest you start now, even before you know your assignments.”

“That’s crazy, why would I get my vaccines before I know exactly where I will be assigned to go? Shouldn’t I wait and see where I go?”

I knew what he was thinking. I’d heard it before. Truth is, it’s a rather good idea to start vaccines before you know where you will be going. Many adults are surprised to learn their children are far better protected with immunizations than they are.

“Most business travelers leave quickly, often with less than 2 weeks notice. You hear a rumor that you may be headed to Sao Paulo, Brazil… but your boss is not sure. You wait. Finally the OK comes and the corporate travel office sends you the tickets a week before departure.
Oops, now there is not enough time to get the vaccines you might need. You see, most vaccines take about 2-4 weeks to become fully protective. This is where the travel department is out of synch with modern medical practice.”

Like most of the business travelers I see, Jim asked for a few minutes to think things over.

When should international business travelers get their vaccines?

This where Jim had it right. He is following the CDC guidelines by visiting me, his travel medicine specialist, at least 4-6 weeks in advance.

This recommendation allows you to receive the proper immunizations and be fully protected before you leave. If you know you will be traveling somewhere, but the plans are not finalized yet you can at least get the basic shots, and then add any destination specific travel vaccines as needed.

If you go to your travel doctor with less than 4 weeks prior to travel, you can still get caught up on your adult vaccines at your visit and discuss strategies for prevention of illness. However, this does leave you in the precarious position of not being as well protected, as you would be if you visited 4 weeks or more prior to departure.

Many people are not aware that you are likely to need a few booster shots since it takes up to 6 months to complete both of the hepatitis series.

Which vaccines do business travelers really need?

You will need to check with your doctor about recommendations specific to you. Most adults are a little behind on their routine immunizations.

You may need any or all of the following common adult vaccines:

  • Tdap has protection for both tetanus and whooping cough.
  • Pneumonia is recommended for people who smoke, are over age 65, or have other medical conditions such as diabetes and asthma.
  • MMR, many adults need a booster. With all the terrible outbreaks in Europe, it would be wise to be protected.
  • Flu, this annual scourge ruins more trips than any other preventable infection.
  • Hepatitis B, recommend for people with diabetes, for frequent travelers and people with more than one sexual partner per year.
  • Hepatitis A, recommended for almost all travelers.

All of the above vaccines are routine vaccines nowadays for children living in the USA; they just weren’t available when you were growing up.

If you know you are traveling to a resource poor area, even if you are staying at a Western-style hotel, you should consider adding the Typhoid vaccine.

There are other vaccines for specific destinations under specific conditions such as Japanese encephalitis, meningitis, rabies, etc. It’s best to discuss these with a travel medicine specialist before choosing them.

What are the bare minimum vaccines needed?

The bare minimum vaccines recommended by the CDC are listed above. Since everyone has different underlying health problems, you should check with your own health care practitioner for advice specific to you.

Can travelers accidentally transmit diseases to your family?

Yes, and this is probably the most compelling reason to get protected with vaccines. Often you become contagious 2 days prior to coming down with symptoms. So, not only will you be sick if you bring home these common ailments, but you will transmit them to your loved ones too. You will feel terrible if you spread these diseases to a friend or relative. Fortunately, your vaccinations will not make your healthy family members sick.

What about last minute change in plans?

Travel is fraught with unplanned changes. A sudden change in destination should be discussed with your doctor since you may need more preventative care. The vaccines listed above are routine adult vaccines, ones you need anyway, so you don’t need to worry if your plans are cancelled. As a bonus, you are protected for future trips.

Crazy as it seems, getting vaccinated prior to knowing where you will be traveling is a good idea.

In fact, this is exactly what the military does for their troops. They provide a backbone of basic vaccines for everyone who is likely to be deployed. Each division then gets specific shots depending upon the area of the world where they may be assigned and their specific duties there. This way, the lack of medical protection does not need to factor into the strategic goals of the unit.

Use military tactics to prepare your workforce

Many human resources departments are adopting this strategy too. This works well since most adults are behind on their standard vaccines–this gives an opportunity to catch up. Additionally, having the Hepatitis A & B vaccines along with the typhoid vaccine makes you worldwide ready and ready to deploy on short notice for most destinations.

Follow Up

Jim decided to get started catching up on his vaccines. With about one week notice he was sent to Shanghai and Beijing. He felt confident he was protected as he headed out to meet new business associates. I am looking forward to hear how things are going when he comes back in for his hepatitis booster shots.

 

Share your thoughts in the comments below. How do you choose vaccines for business travel? Are you current with your adult vaccines?

 

 

Tips for International Travel With Children

 

Passport

 

The Girl Scouts entered the border crossing office like soldiers: silent, single file, and in full uniform.

As the agent inspected the “troops” their leader   presented The Binder. (The documentation needed to travel internationally  with an entire Girl Scout Troop is measured in pounds, not pages.)

Rainbow Bridge was just beyond the door….

Three months’ worth of preparation lay open in front of him. A few questions and then,  “Welcome to Canada!”

Travelling internationally with children is a joy, however  it requires advanced planning and research. Passports, prescriptions, insurance cards? Custody issues? Children with special needs?

The answer is the same: “There is a form for that.”

How to Get a Passport for a Child

Start with obtaining the passport. Your child needs a passport to travel internationally and getting one can take  up to 8 weeks, maybe longer.

For a child under 16 years of age you must apply in person and you will need to take the following:

  1.  THE CHILD.
  2.  Money: up to $120 depending….
  3.  Evidence of U.S. Citizenship: for example, a certified birth certificate
  4.  Evidence of Parental Relationship: usually on the birth certificate
  5.  Photo ID for the parents: driver’s license, passport, etc.
  6.  Parental Consent: both parents should be there if possible
  7.  Passport photo of the child
  8. The application itself, downloadable

A minor  of  16 or 17 years of age can apply alone, but parental presence is recommended to demonstrate “consent to issue” the passport.

Taking a passport photo of a baby sounds harder than it is. You can do this for free at home. Using a digital camera, wait for the time of day when your baby is at her best. Place her on a white sheet on the carpet, or prop her in a car seat draped with a white sheet.

Need help with with sizing and cropping the photo as well as much more information  about applying for passports? Detailed advice is available here.

What if Dad isn’t travelling with us? What if we share custody? What if it isn’t my child?

You will need a copy of the legal custody or guardianship document, and/or notarized consent from the non-travelling parent(s).

Health Insurance for People Travleing Abroad

Young kids get sick a lot.  Motor vehicle accidents are common. It can cost $50,000 or more for an international air ambulance evacuation home.

Contact your health insurance provider for the limitations of your plan. What does “out of network” really mean? Bring along  your child’s insurance card and contact info for authorization and billing.

Also consider obtaining International Travel Medical Insurance that includes Emergency Evacuation Assistance. Your travel medicine specialist can direct you to several plans.

How to Bring Medications Along

Travelling with children often means travelling with  medications.  Someone, it seems, is always on the pink bubble gum medicine. Holiday travel may be a bad time for a  holiday from ADHD meds. You want your child as well as the rest of family to share the most meaningful experience possible.

Be careful here. Prescriptions should be in their original labeled containers. Consider bringing along a recent, dated letter from the pediatrician on her/his letterhead stating the name, dose, and diagnosis for which the medication was prescribed. A copy of the original prescription is also helpful.

Be sure your child’s meds are travel-legal! The consulate of your destination can help you determine what meds you can take in with you and which require alternatives or an in-country prescriber. Certain pain meds and ADHD meds, for example, may be banned at entry. Delay, embarrassment, stress, incarceration are possible outcomes if you get this wrong.

Traveling With Children Who Have Speical Needs

What if your child has epilepsy and has a seizure after a visit to the Butterfly Park in Singapore?  What if he has asthma and isn’t doing well after hiking in the Black Forest? What if she has had a kidney transplant and develops a high fever as the cruise ship docks in Grand Cayman? First responders and emergency department caregivers will want a lot of information from you, fast!

Travel with the “Emergency Information Form for Children with Special Health Care Needs.” Your child’s doctors have access to this document designed for children with particular medical challenges. You and your child’s doctors(s) will complete this together. It is invaluable when treating a child with special health care needs in an urgent situation.

You may want to scan your child’s travel documents for access as a backup plan, but always have the original paper documents with you. Remember, paper never “crashes.”

Do you have tips for traveling with children? Share them in the comments below:
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How Do You Find a Doctor When You Are Out of Town?

Alta Clinic 

We gleefully fly through the gates marking the edge of the trail off into the off-piste snow.

You don’t get too many days like this; no sense wasting it on groomed trails. Ann, my 20 year old daughter, skillfully shoots down the mountain, but something goes wrong. She tumbles head over heels before crumpling into a pile on the slope.

Terror & guilt. My baby…is she hurt? Is she hurt bad?

Slowly, Ann starts moving.

Relief, her ski has come off, preventing a knee injuy. But she can’t get the ski back on because her hand is too painful.

Carefully, my brother helps her put the ski back on after muttering something about the ski robbing her of a powder run. He is relentless like that…in his pursuit of powder!

It is a storm rider day, a day where snow is falling fast, a day where skiers speak in hushed reverent voices…afraid to let their excitement show. My brother’s children have abandoned him at lunch, something about being too tired and cold. And so he is on a mission to make sure we don’t miss this sacred moment of skiing.

We start to ski again but her hand is too tender; she can’t hold her pole. And that’s when I begin to suspect that she has injured herself.

At the bottom of the run, Ann pulls off her glove so that I can examine it. Swollen, tender, and black and blue…it is obvious to the untrained eye that her finger is broken.

We are away from home, in Utah. What should we do?

The café gives us a bag of ice for the hand while I scrounge some ibuprofen from deep inside my jacket to give to her. Then we pull out our phones to locate a doctor. This is the age of Google after all, so it seems logical to check the reviews of the ERs in town.

Thank goodness for smart phones. Instantly you have the world at your fingertips, which is especially helpful when you are out of town, away from your local network.

How Can You Find a Doctor When You Are Out of Town?

  • Check with your insurance company online. It sounds obvious, but it makes a big difference in how things get paid. Some plans have preferred providers, some have preferred types of care (Urgent Care vs. ER). In Ann’s case, her insurance wanted her to start at an Urgent Care and move up to an ER if needed.
  • Online reviews can be hit or miss. Sites like Healthgrades keep data about training, specialization, etc.  Be careful, there are too few reviews at this point in time to rely on them. Your insurance plan may have reviews of in-network providers. Ann’s insurance had extensive online reviews…so she was able to find a good specialist for follow up that way.
  • Ask a local, they usually know what isn’t written down in the reviews. Where do they go when they are injured? Of course your information is only as reliable as your source, but people are generally very helpful and quite knowledgeable. You can always double-check the facts with another person or Google search.
  •  Can’t find anyone? Go to the ER at the local University.
  •  If you are traveling out of the country the International Society of Travel Medicine (ISTM) and the International Association for Medical Assistance to Travelers (IAMAT) have directories of English-speaking doctors. You will need to check their credentials and specialization to see if they meet your needs, but generally speaking they are a great place to start.

Ask a Local

That’s when we notice Moqui, the ski patrolman enjoying a cup of coffee at the café. Moqui encourages us to use the resort doctor. He tells us the doctor in the clinic takes care of this type of injury all day long. And they do indeed have an X-Ray machine and the ability to apply splints. Exactly what Ann needed. He says Ann should definitely have it taken care of today. He pulls off his glove to reveal weathered hands with a large lump on top– the result of not getting immediate medical care for an injury, or so he says. Some quick directions and we were off.

“The Hand is Here, call Bob”

The clerk calls out, “The hand is here, call Bob” as Ann walks into the small clinic with her entourage (us). The bright, well appointed clinic has a pleasant waiting area stocked with an ample supply of Powder Magazine, a magazine devoted to photos of impossible ski stunts which usually land you in a clinic of this sort.

She is greeted by a friendly woman who explains the process, including how to get access to her medical record online when she gets home and the fact that they don’t accept insurance. Ann will need to submit the paperwork (given at the end) to her insurance company for reimbursement. Now this is okay in the U.S.A., but if you are abroad you will want to purchase a very affordable travel health insurance policy. Most health insurance plans are not accepted abroad. It can be rather expensive to pay your medical bills upfront, especially if you will require hospitalization. If Ann had needed more than an Urgent Care visit, we would have driven to the local ER, which was only an hour or so away.

The clinic is staffed by avid skiers who sneak in a few runs when the clinic is slow. In fact, the doctor still has his ski pants on while he was busy helping a 20-something with his busted knee and an older man with some sort of shoulder injury. This instantly makes us feel comfortable- people with the right expertise who also share our passions.

Dr. Ken

The nurses move Ann back to the treatment area, make her comfortable, and explain the process to her. First the doctor will see her, then an X-ray will be taken, and afterwards any needed treatment will be given. Doctor Ken Libre of the Alta Medical Clinic is right out of a television program: tall, kind, thoughtful, he instantly wins us over. A quick check on Healthgrades reveals he is very well trained in Family Medicine, and rather smart too since he graduated from Dartmouth Medical School.

He examines her and orders an X-ray. That is when we noticed the X-ray tech, Bob. He suddenly appears still wearing his ski boots, wet with fresh snow in the buckles.

This is definitely a clinic for skiers staffed by skiers.

Dr. Ken reviews the X-ray, examines her hands, takes some photos, and contacts a hand specialist. It is comforting as a parent to realize that this clinic has access to all sorts of specialists who can provide a virtual consult via a ‘smart’ phone whenever it is needed. This removes any doubt I might have about where to take an injured family member.

After some discussion, Dr. Ken recommends straightening the finger in the clinic, placing a splint, and having Ann follow up with a hand specialist in her hometown. She leaves with a bandaged hand, easy to understand instructions, and copies of her X-rays for the specialist.

Follow-Up

The next day we see Moqui on his snow machine off to help another injured skier. He slows down to ask Ann how things went, and is pleased to see she had a proper splint applied and will see a hand specialist upon her return home in a few days. Several weeks later, her hand works well.  Which is very important, since she works with computers for a living, and her fingers are straight and beautiful…no lasting lump.

Hand in splint

I hope you never need to find a doctor when traveling. However, just in case, as part of our travel consultation at TravelReadyMD we help identify doctors at your destination who can see you in the event you become ill while traveling.

Have you ever become sick or injured while traveling? How did you find a doctor? Share your story in the comment section below.

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Review of Grass Roots Injury Prevention: A Guide for Field Workers

GRIP Guide Samarakkody, D., Elizabeth Davis, and Rod McClure. Grass Roots Injury Prevention: A Guide for Field Workers. Rugby, UK: Practical Action Publishing, 2013. Print.

This book resonated with me immediately. I wish I had read it about 5 years ago. That is when I took my children, in their early teens at the time, to volunteer at a site where a home was being restored for a family in need.

Home Building: Site Dangers

We joined the team when siding was being hung. My kids and I cut pieces of vinyl siding  to specs so that the pieces would  fit neatly around the windows. Then we handed these cut pieces of siding out the nonexistent windows to men perched high on ladders.

So far so good.

There was a designated footpath from the parking lot across the “lawn” and a long plank  which crossed the nonexistent front porch and up to  front door. All nails and shrapnel were to be kept off this designated route. All workers were to be kept on this designated route….. Sure.

Someone started to sweep up 80 year old house dust. And as the sun set it got colder. Of course it did: no furnace yet and no  actual windows.

Soon a nice young man offered to teach my daughter how to use a hand held power saw to cut wood and she was ready to learn.

Afterwards, we thanked them for including us and made our way down the special path to our car, proudly clutching our official worksite t-shirts.

It doesn’t surprise me that, years later, my daughter would become an engineering student at MIT. (They have a whole shop filled with power saws there.) What does surprise me was that no one went to the emergency room that night with a nail in their foot, wheezing, hypothermia, or a laceration. 

When I was asked to review this book, I recalled the day we spent at the homesite and completely  understood its relevance, both in the developing world, and maybe even in Western Pennsylvania.

This book is just what is needed.

The Science of Injury Prevention

Diana Samarakkody has expertise in public health and epidemiology, devoting herself to injury prevention and management. She is a Post-Doctoral Fellow at Monash University Accident Research Centre in Australia where she teaches undergraduate and postgraduate medical students. She serves as the National Program Manager for Injury Prevention and Control at the Ministry of Health in Sri Lanka.

This book is a collaboration. Dr. Samarakkody, the coauthors, and  contributors are all equally worthy of credit for their life’s work and writing in the causes of health, safety, and promotion of peace.

A Practical Guide for Field Workers

Take one look at the cover and you already understand what this book is about.  And you think, “At last!”  Susil Jayashantha Perera’s  spot-on art  depicts a woman in a medical uniform, quite literally “in the field,” sharing printed information with lay people, engaging a local woman in discussion as others gather.

Hint: I don’t see a hospital in the background. This book is a manual for this health worker and all who follow in her footsteps. Its illustrations complement and enhance the text nicely.

Academic works on the science and principles of injury prevention abound …thankfully! This book, also known as the “GRIP Guide”, will serve as the critical, final link in the chain between all that scientific knowledge and “field workers who want to make their communities safer.”

It starts with a brief, motivating discussion:  “Everyone in a community is affected when someone dies or is disabled by an injury.” Lower- and middle-income countries account for 90 percent of global deaths due to injury.

Yes, a family can lose its breadwinner, but  this book also reveals a sensitive awareness of the nonmonetary impacts of injury. It spans the concrete, such as pain and bleeding, and  the profound: “Loss of dreams and expectations of marriage and children,” and loss to the “social and cultural life of the community.”

It empowers the field worker, including those with no formal training in medicine, public health, epidemiology, or public speaking, to tackle this challenge onsite. There are no big lectures to give or manuals to hand out. Instead, the reader learns step by step how to empower communities to face their own challenges and to sustain their own work.

How to Begin an Injury Prevention Program

It begins with the basics of forming a group, brainstorming, using case studies as teaching tools, mapping the community with respect to potential risk, and moves on to creating calendars and charts, leading field visits, and addressing ethical issues.

It slows down on the exact definition of injury and a discussion of specific types of energy but then moves on to vivid  examples of energy sources that can cause harm: stampeding animals, harvesting knives, landmines, chemical fumes, bodies of water….

Next come modules, which can be used in sequence, or as freestanding lessons addressing specific types of injury, for example, “Burns” and, “Transport Injuries.” Along the way case studies are used featuring a fictitious worker, “Dula,” and her fictitious village. These realistic stories, along with the accompanying illustrations will help the worker hold the attention of locals and teach them  what they need to know.

Perhaps the wisest advice given is to be sure, whenever possible, to enlist the involvement of international agencies, local public health staff, the school principal, religious leaders, elders, etc., in addition to an intentionally diverse group of residents.

I have to admit that on first reading, I felt the book was elementary.  Then I read it again and understood it is exactly what it is designed to be and exactly what has been missing. Grass Roots Injury Prevention trains the field worker, from scratch if needed, using an elegantly appropriate writing style and illustrations that enhance.

With this guide, the field worker will enable communities to get injury prevention right and sustain it.

In summary, this book will save lives.

 

Note: Practical Action Publishing deserves mention here as it is a company committed to “supporting international development through the dissemination of knowledge.”  This company prints books and peer reviewed journals. It collaborates with over 70  groups including the World Health Organization and United Nations Children’s Fund, and offers a book voucher and donation system. This system provides published resources for those who need them most, but may not have the financial or logistical means to obtain them.

 

Have you experienced a preventible injury? Share your experiences or thoughts about Grass Roots Injury Prevention in the comments below.

Avoid Being Arrested When Flying With Children.

Arrested in HandcuffsThe lime green Gameboy almost got us arrested.

I told my son that on travel days, he had unlimited gaming time. He was a happy boy. But he wasn’t prepared to give it up for scanning at the security checkpoint at the airport. My mistake.

Questions. Resistance. Tears. Then we watched in horror when the battery cover  popped off and the batteries rolled across the floor. Of course he darted to retrieve them, and I ran to retrieve my son. I am sure it was caught on video.

Thanks to the new kids page on the TSA website, this should never happen to anyone else flying with children. Features include, “Pick a Page and Color It,” “Meet the K-9 team,” and a delightful teaching video. Mom, Dad, and the TSA officers are nice doggies. The kids are puppies who experience the airport screening process well prepared and quite happy.

It makes “Stop. Screen. Go.” Look like fun. The little girl-puppy knows she will soon be reunited with her bear and the boy-puppy is properly prepared  to put his hand-held game in the bin. Dad reassures them that the baby’s milk bottle will be returned too.

Our family dentist once told me to be sure and cherish the travel time with my children. The adventure begins as soon as you leave the house.  He was right. They have gone to college now and I would give anything to spend 2 hours with them in an airport. Really.

Preparation is key.

Automatically flushing toilets in can be terrifying for little ones. Bring along some  stickers to loosely place over the sensor until the right time for a flush.  These also make good rewards for “trying to go” before boarding

Comfy clothes, special snacks, a favorite blanket, some toys, and hand sanitizer gel are the basics. Bring the usual diaper bag items and don’t hesitate to use Pull-Ups for recently trained toddlers. You may not be able to leave your seat when nature calls.

Kids of all ages will delight to surprise, wrapped gifts rationed strategically along the journey.  I  stocked up on these at our local dollar store before travelling with my twins. Extra batteries for hand held devices, chargers, and for older kids, headphones are a must.

What about the car seat?

Your arms are not strong enough to restrain your child in an air emergency and you will need it on your trip when you travel by ground.

The FAA and the NHTSA websites offer guidelines. In short, purchase a plane ticket for your child. Your child is safer in a FAA approved  Child Restraint System and the airlines must accommodate this.

If your child is 22-44 pounds a special belt and buckle harness combo, “CARES,” is an alternative that is much less cumbersome. This Child Aviation Restraint System is approved only for airplane use, so you can check the car seat with your baggage.

Can I take baby formula, breast milk, and liquid medications over the 3.4 ounce limit  on the plane?  Can you imagine having to measuring out exactly 3.4 ounces of formula for a bottle?  Thankfully, you don’t have to!

First, carefully pack what you can in your checked luggage. Then you should be able to carry on what you need as long as you notify the TSA officer on arrival to the security checkpoint.

For air travel with children, prepare the best you can. Pack your sense of humor. And enjoy the journey!

Do you travel in airplanes with children? Share your stories in the comments below:

 

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7 Things Your HR Director Wants You to Know About Traveling With Asthma.

traveling with asthmaYou’ve been assigned to Beijing, China for a business trip. Should you go?

You don’t want to miss this opportunity, yet at the same time suffering through an asthma flare up while traveling gives you the willies.  On the one hand, you’re so good at managing your condition that you’re not even sure your boss knows about it. And on the other, you’ve heard your workmates complain about an irritating ‘Beijing Cough’ when they travel there.

The experts all say your goal for living with asthma should be a symptom-free and fully active life.  Sounds great, but how do travelers actually do this?

7 tips to help you prepare and manage your asthma while traveling.

1. Good Baseline Control.

A great place to start is to get your asthma under good control before you travel.

Exposure to increased pollution, passive smoke, respiratory infections, and the extremely dry air on planes are all likely to trigger an asthma attack.

  • See your asthma doctor to have your medications reviewed.
  • Learn to avoid respiratory infections through good hand washing.
  • Receive any needed vaccines such as the flu shot.

2. Asthma Travel Kit.

Prepare an asthma travel kit, complete with controller medications, rescue medications, spacers and other necessary medical devices. You’ll want to carry this kit with you instead of putting it in checked luggage. This is good time to update your asthma action plan since you’ll need to carry it with you. Have your doctor write down your condition on letterhead including the names of medications you use and a treatment plan for flare-ups

Don’t’ worry about clearing TSA security– medical devices and medications are allowed through screening, but may be subject to additional search; call the TSA at least 72 hours prior to departure for specific information.

3. Avoid or Reduce Known Hazards.

It’s imperative that you arrange for a smoke-free hotel room. The lingering chemicals left in the air by smoke are commonly associated with a flare of respiratory symptoms.

Try to avoid travel to highly polluted cities, including Beijing. If you must go to a city with high air pollution stay indoors as much as possible. Unfortunately the popular white face masks do nothing to protect you from pollution.

If you have allergies- do your best to avoid allergens:

  • Pollen: Avoid visiting cities at times of the year with high pollen counts.
  • Dust mites: bring own dust covers for pillows and bedding.
  • Mold allergy: Avoid damp environments and musty houses.

Will you be staying in a private home? Are there pets or smokers there? If so, I suggest that you find alternate accommodations to avoid triggering a flare-up.

The dry air on planes is very irritating to your lungs, be sure to drink plenty of water while flying to help keep up with hydration.

4.Travel Health Insurance.

If you have a chronic health condition it’s best to have a health plan that covers you worldwide. Many companies purchase policies for their employees who travel. Check with your HR professional to find out what your company offers. You can always purchase inexpensive policies online. This insurance is very affordable—it’s designed to cover costs of healthcare abroad, including repatriation. Surprisingly, the cost of this insurance is far lower than the cost of changing your airline ticket. And, if you need to go home for medical care, they cover the cost of your changed airline ticket or air ambulance (if needed).

5. Get Vaccinated.

Talk to your doctor about adult vaccines. Most people with asthma need protection against influenza and pneumonia. It’s far better to be vaccinated than to have these nasty lung infections interrupt your travels.

6. Identify a Doctor at Your Destination.

In the event of a flare up, it’s nice to have already identified a local doctor who canhelp you. Your asthma doctor may be able to refer someone. Additionally, the International Society of Travel Medicine is an excellent resource for finding doctors around the world.

7. Travel Buddy.

If you’re traveling with a colleague or friend, let them know you have asthma and what they should do in the event you have a severe flare of your condition. They should know that you have specific ‘rescue’ medications and how to get  you to a doctor (see #6). It’s unlikely that you’ll have such a severe flare up….but it’s best to be prepared.

There you have it, seven strategies to manage asthma while traveling. It’s a personal decision whether or not you accept the assignment. You’ll need to balance the responsibilities of your job against your personal health.  Have your doctor help you figure out the safest way to travel and the best ways to avoid a flare up. An ounce of prevention is worth a pound of cure – especially in these situations!

Do you have any tips about traveling with asthma?  Share them in the comments below.

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Traveling to India? Don’t Let Delhi Belly Ruin Your Trip.

Stomach PainDinner Invitation

We knocked on the wooden door, Tasfaye opened it, welcomed us into his home.  The smell of home cooking and roasting coffee beans permeated the house…and then Delhi Belly set in. My insides gave way— like a scene from a bad movie I rushed to the bathroom and spent the rest of the evening there, ‘in disposed’ shall we say. I didn’t know so much could come out of me.

I was just 20, what did I know?

I certainly didn’t know I could avoid travelers diarrhea (TD) or treat it. I thought you just had to put up with it if you want to see the world. I was in Ethiopia at the time, so I assumed that intestinal maladies were part of ‘the experience’. I suffered that night, and for days afterwards. What bothers me most is that I missed a wonderful dinner with professional colleagues and several days of work too.

I have since learned that there are many things you can do to avoid ‘Montezuma’s revenge’, ‘Delhi Belly’, the ‘Azetec Two-step’ or whatever cute name you want to give it.  And if you become ill while traveling, you can treat yourself immediately- lessening both the severity and duration of symptoms.

TD is simply awful. You feel terrible, can get dehydrated, and usually have to miss several days of planned activities while you slowly get better.

Poor food handling or contaminated water is always the source. In many destinations, especially resource poor countries, improper food handling is the main culprit.

Beware of the buffet.

You can be lured into a false sense of security if you judge a restaurant by its décor. That certainly happened to my trekking group in Peru last month. We had been meticulous about food and water until we were invited into a very nice restaurant in the Urubamba valley.  It looked so fancy that some forgot first rule of traveling—beware of the lukewarm buffet. In no less than 36 hours we were paying the price: severe cramps, fever to 104, and explosive diarrhea. One member of our party even needed an IV to recover!

How can you prevent travelers diarrhea?

  • Be conscientious about good hand washing. Wash before you eat and after you use the restroom. Soap and water is best, but if not available, hand sanitizer will work well.
  • Eat food that is freshly cooked and served hot.
  • Don’t eat food from street vendors.
  • Drink only bottled beverages and skip ice, which is made with tap water.
  • Avoid lettuce and other hard-to-clean leafy vegetables
  • Wash fruits and vegetables and peel before eating them.

How do you treat travelers diarrhea?

Oral rehydration: The mainstay of treatment is to maintain good hydration. Oral rehydration salts are available worldwide. Savvy travelers bring them along- in the USA they are sold near the infant formula in supermarkets. (Pedialyte, etc). You simply mix the powder into your water bottle, and they help rehydrate you despite your illness.

Antibiotics: Talk to your travel medicine specialist. You may want to take antibiotics along so that you can treat yourself at first onset of symptoms. This reduces both the severity and duration of the illness.  Different antibiotics are recommended for different destinations, your doctor can help you choose an appropriate one.

Loperamide: For those times when you don’t have access to a restroom (think safari, airplanes, etc) Over-the-counter aides can slow things down until you are near facilities. Loperamide does not treat the illness, only the symptoms.

Doctor: Of course for severe symptoms you will need to see a local doctor.

The good news is that TD is not an inevitable outcome of traveling abroad. Simple preventative measures minimize your chance of becoming ill.  Just in case, bring along a few supplies such as antibiotics, rehydrating salts, and loperamide so that you can quickly and effectively treat yourself at first onset of symptoms.  This simple plan will allow you to spend more time doing what you planned at your destination and less time taking care of illness.

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How to you avoid Delhi belly? How did you treat it? Share your story in our comments section:

What travelers need to know about Typhoid Fever

Typhoid FeverRuth May Upton was not the typical teenage girl of the early 1900’s.  She loved the outdoors.  Every chance she could, she jumped on her horse and tagged along with her father as he travelled to the far reaches of his Virginia farm.  They met with farm employees, checked on the livestock and inspected the vast fields. It was a grand adventure for Ruth May every time. She was actually a big help to her father.

Somewhere out there, or perhaps from a guest back at the family’s inn, Ruth contracted typhoid fever and nearly died. I’m especially glad Ruth May recovered because she was my Grandmother and we were very close.

There were many cases in the U.S during the early 1900’s,something hard to grasp in light of advances in sanitation and healthcare in the U.S. today. Everyone didn’t recover. Some  parts of the world still see cases of Typhoid Fever in large numbers.

Do I need a typhoid shot for my trip?

It depends on where you are travelling and how adventurous your eating habits are. Typhoid fever is more common in developing countries, especially Asia, Africa, and Latin America. It is more common in settings where handwashing is infrequent and water is likely to be contaminated with sewage.

I don’t like shots. Is there an alternative?

The typhoid shot is approved for travelers age 2 and up, but if you are at least 6 years old, there is definitely an oral alternative. It is a little tricky: 4 capsules taken over a period of 8 days, but this vaccine lasts much longer. And it doesn’t hurt!

Is typhoid fever really that bad?

Typhoid fever can be life threatening. If you eat or drink something contaminated with typhoid, the bacteria multiply in your gut and then move into the bloodstream. As long as a month after exposure you may develop fever, aches, headache, enlarged liver, and a rash. Death can happen from intestinal bleeding or perforation.

That sounds terrible! Can it be treated?

The right antibiotic and good medical care make a huge difference. Your TravelReadyMD doctor not only can give you preventive vaccines before your trip, but also can help you make a plan for obtaining emergency treatment or even affordable medical evacuation to a hospital back home should you become seriously ill.

What else can I do to avoid typhoid fever?

Typhoid fever is passed from human to human through contaminated food or beverages. Asymptomatic carriers exist.

To avoid food or water borne illness in general, remember, “Boil it. Cook it. Peel it. Or forget it!”  Water that is bottled, carbonated, or has been boiled for a full minute, (without contaminated ice) is safe. Fruits and veggies that you peel yourself, or that are serving piping hot are safer. And always be careful with food from street vendors, lukewarm buffet food, and unpasteurized cheeses.

I’ll never remember all this on my trip!

At TravelReadyMD we review your itinerary and compare it with real time worldwide updates to determine your level of risk for typhoid and other travel related illness. At your appointment you will be given a reference booklet prepared just for you to tuck into your suitcase. Wherever your journey takes you we can help you be safer and healthier along the way!

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