Dr. Magill’s Revolutionary Plan for Treating Malaria.

babyIt’s the thinking that is all wrong.

You slide into your seat, trying not to jostle your fellow conference attendees. It seems so familiar: the padded chairs in a non-descript color, the small podium at the front of the room with larger-than-life PowerPoint slides projected on twin screens, flanking a panel of industry experts sitting at the elevated table.

This is a most unlikely place for a single man to completely change the thinking of hundreds of well-educated dedicated healthcare providers.

You have gathered in Quebec with your fellow tropical medicine professionals to learn the newest ideas and techniques for keeping people safe when the travel. Today’s talks are centered on treating malaria.

All morning the talks have focused on resistance to malaria medications and insecticides. Experts have shown with pinpoint accuracy the burden of malaria by chronicling lives lost, persistent poverty, and the danger caused by fake medications.

A middle-aged balding man with glasses and a greying beard takes the podium. Polite applause.

You know he has something important to say. After all, his entire job description at the Bill and Melinda Gates Foundation is “Eliminate malaria”. Only two words, that’s it.

You wonder. What will be the new weapon?
Is it a new drug? Maybe a vaccine? Better insecticide?

So you listen.

In a calm voice, with warmth and confidence Dr. Magill reviews our current battle plans. How we developed new tactics and weapons for the war on malaria.

With each new drug or technique, with each escalation the malaria parasite develops better resistance. You realize we are caught in an arms race with a parasite as old as humanity.

You nod. You know all these things and more. Good, you think to yourself. I’m up to date. I know what I need to know.

Malaria is a terrible infection. It causes untold tragedy in many tropical regions of the world. It’s a vicious killer; it’s preferred targets are pregnant women and young children.

In people who live, it causes recurrent or chronic infections and profound fatigue. Unable to work, crops don’t get planted and work doesn’t get done. Like an occupying force; it perpetuates a cycle of poverty and misery.

It’s also very dangerous for travelers. Visitors to infested areas can become very ill and die. They become collateral damage in a war between a parasite and mankind.

That’s when Dr. Magill calmly and quietly explains how you have been thinking about malaria all wrong:

“To save the life of the child, you must treat the mother and father.”


Don’t just treat the sick person, but eradicate the reservoir of disease, which is hiding within other people. Malaria is hiding within the family members of the ill child. And they don’t have symptoms.

People stop tapping on their phones, sit up in the chairs and listen intently as he systematically lays out plans for guerilla warfare.

This is no ordinary foe. It has been hiding in towns and villages, right under our noses. This enemy is well camouflaged.

He exhorts us to root out and choke off support for these terrorist parasites. To isolate and eradicate the parasites in the dry season. At a time when they can’t escape in the bellies of mosquitoes to spread their misery to neighboring villages.

You shift uncomfortably in your seat. It seems so obvious. Why didn’t we think of this before?

For years we have been battling malaria on many fronts- install systems for better care for sick people, better drugs to attack the parasite, better insecticides and nets to kill the mosquitoes that transmit malaria. And what do we have to show from this traditional plan?

Drug resistant parasites that swoop down in the middle of the night attacking sleeping villagers.

Inventing better weaponry is not sustainable.

Better drugs and better mosquito avoidance measures just lead to an escalation of warfare. An escalation of resistance. We need a new battle plan.

And Dr. Magill has it.

With a strangely reassuring bass voice he gave us our new plan for treating malaria. A methodical clear and hold strategy. You never let up.

You track the malaria parasite down in every town and village. You snuff out each little ember of resistance during the dry season, at a time when the parasite cannot mobilize and escape via mosquitoes.

You get the malaria out of the people. All the people, not just the sick ones.

This will take some coordination between tactical education forces, governmental programs, and medication supply.

In those areas where this has begun, there has been a persistent decline in deaths from malaria.

You wonder, how does this affect the traveler?

You realize that some day very soon people won’t need to take malaria pills when visiting tropical parts of the world. That you won’t see returning travelers with delays in diagnosis due to unfamiliarity of the disease. For now you will still need to advise people on ways to prevent and treat malaria while traveling. But the end is in sight.

But even more profoundly you wonder how can you apply this thinking to other problems? Which problems need a fresh pair of eyes?

You realize that how you define the problem is the key to how you design the solution.

Dr. Magill wasn’t tasked with find better drugs, fix healthcare infrastructure in malaria prone areas, or develop new mosquito avoidance procedures. He was given one simple task: Eliminate malaria.

And it looks like he is going to do this by using new thinking.


At TravelReadyMD we teach you stay healthy while traveling. Why? So that you can feel better and get the job done when you travel. We do this by offering educational programs in a variety of formats. Contact Dr. Sarah Kohl for a free 20-minute consultation, to see if one of the educational programs is a good fit for your organization.

MERS Viral Infection. What do Travelers Need to Know?

Man in maskFaces of people wearing surgical masks are splashed across the news worldwide.

In South Korea over 165 are confirmed infected, 23 have died and 6,000 more are under quarantine. Schools are closed and the World Health Organization (WHO) is on the scene.

It sounds so dire.

But does this make sense? How exactly did the MERS viral infection get lose in South Korea? Do you need to curtail travel or worry?

First a little biology lesson (don’t worry there’s not a quiz).

What is MERS-CoV? 

MERS-CoV, previously known as ‘Saudi SARS’, is a viral infection caused by a coronavirus.

These viruses are common causes of respiratory infections. Symptoms include fever, cough, shortness of breath, and fatigue. Some also suffer sore throat, nausea and vomiting. In people with underlying health conditions, it can become quite serious.

Each particular strain of coronaviruses can infect either humans or other animals but not usually both. This particular strain is different. It can affect both humans and animals.

We don’t know where this strain came from, but investigators are looking at camels and bats as possible sources.

Treatment involves supportive measures. There are no specific medications to prevent or treat MERS-CoV

All known cases of MERS-CoV have been linked to travel to the Arabian Peninsula.

What happened in South Korea?

The current situation began when a traveler to the Arabian Peninsula returned to home to South Korea. Soon after returning he developed a cough, fever, and shortness of breath.

He visited several medical facilities, each did not know why he was sick and referred him to another medical center for evaluation. Since MERS had never been reported in South Korea, it took a little while for the doctors to figure out what was wrong with him.

While at the medical centers he underwent a lot of testing to try to figure it all out. With so many diagnostic possibilities it took some time to get the answer.

During the course of his quest to get better he accidentally exposed people at the hospitals [health care workers and fellow patients] by coughing.

Once the doctors figured out that he had MERS he was promptly isolated and they began the arduous task of tracking down and monitoring all of his contacts.

Why are people closing schools?

Human psychology is a funny thing. We are hard wired to worry about new or unfamiliar things. It’s deep in our DNA. And this outbreak is no different.

You can imagine that if a respiratory illness got loose in our community and people started dying you might feel quite nervous. I know I would.

It’s no different in South Korea. Fear, not logic, began to grip the general public. While understandable, but not needed, the public called for responses such as closing of schools, cancelation of large public gatherings and began wearing surgical masks in public.

But the only people actually at risk of contracting MERS were exposed at the medical centers and were being monitored very closely. Not the general public.

That is why The World Health Organization and other authorities have called for the re-opening of schools and general calm. To date, all cases identified in South Korea can be traced back to the accidental exposure through the healthcare system.

What should you do if you plan to travel to South Korea?

Continue your travel to South Korea as planned. No authoritative agency is recommending any changes in travel plans.

Feel comfortable using commercial airlines. No suspected or confirmed cases of in-flight transmission have ever occurred.

The South Korean public health system has identified and is monitoring all known contacts of the original infected man. All of the people infected with MERS in South Korea can be traced back to accidental exposure through the healthcare system, before the isolation procedures were put in place.

All Travelers should:

Practice good hygiene and take care when ill:

  • Wash your hands often.
  • Practice cough & sneeze etiquette, and stay at least 3 feet away from people with fevers or respiratory symptoms.
  • If you are sick, stay in your hotel room. Except, of course, if you need healthcare.
  • Don’t touch your eyes or mouth.
  • Avoid contact with animals, especially camels.
  • Check with the CDC before travel to determine if there is an outbreak at your destination.
  • If you become ill with a fever or respiratory illness within 14 days of travel to the Arabian Peninsula advise your doctor about your recent travel.

This current outbreak should come to an end soon. As it winds down, we should all take a look at our travel itineraries and ask ourselves:

How can we better educate ourselves about emerging health problems?

What can each of us do to minimize our chance of becoming ill when we travel?

It’s clear we are part of a global community. And germs take advantage of that.

Contact me if you are concerned about keeping your team healthy as they move around the world. We can discuss whether my education program is a good fit your organization.

Business Traveler Safety: Are You Worrying About the Wrong Things?

Worried Business WomanIf you travel abroad which is more likely to kill you? A terrorist attack or texting while driving?


Ever notice how we worry about the wrong things? We worry about far off and distant dangers such as terrorism but aren’t bothered by common dangers like car crashes?

Yet by the numbers driving is the most likely to kill you while abroad, far more common than kidnapping. Or victim of terrorist attack.

27% of the deaths of American citizens in foreign countries are in car crashes.

Yet It’s perfectly reasonable to focus on the crime and terrorism worldwide. You’re hard wired that way. Your brain is designed to be wary of new things, things that might be a danger, things that are unfamiliar.

And the 24-hour news cycle is complicit and amplifies your fears.

Next thing you know you are in a full lather and your worry that your employees might be unsafe, your company is responsible for them and you haven’t done enough to protect them.

If your listen to some security ‘experts’ you might think that you think your CEO will be kidnapped and ransomed for some ungodly sum of money.

All the while there is a real danger is lurking, ready to snatch your CEO in a moment notice…. It’s not a kidnapping, it’s a car crash or a heart attack.

Of course you didn’t know that people were manipulating you and your inborn fear of unfamiliar dangers. The most rational option is to use data to identify what you should worry about.

You should worry about driving in developing countries, especially Mexico the Philippines, Dominican Republic, India and China and Costa Rica. These six countries are frequent destinations for US citizen and also have the dubious distinction of unusually high per capita deaths due to car crashes.

These are the places your employees are most likely to die in a car crash while traveling. These are the places the data tell you to spend your resources to protect your employees.

What can be done to minimize car crashes while abroad?

To increase car safety  your company can implement several ways to minimize unsafe driving

  • Hire professional drivers for your employees. There is no sense having a sleep deprived, jet lagged valuable team member at the wheel when, for very little cost, you can hire a reputable, wide-awake professional driver who is familiar with local road conditions.
  • Insist that all vehicles have seat-belts and have regular safety inspections.
  • Insist upon the driver obeying the speed limits. If needed you can even pay the driver to ‘slow down so I can take some photos’ or pay a bonus to drivers who stay under the speed limit.
  • Avoid nighttime travel. Unlit, poorly paved roads are very dangerous at night. This danger increases substantially in less less developed countries.
  • Ban texting or talking on the phone while driving. Everywhere.

It’s easy to see why people have trouble with car crashes while abroad.

On my recent trip to China it was rare to find a seatbelt in any taxis. Even in Beijing. Even in Shanghai. Although the roads are improving, we had our share of hair raising ‘near misses’, scary enough to make you take stock of your life, while being ferried around in taxis.

What are you waiting for?

When you are working with your travel management team and your traveling employees be sure they understand the importance of auto safety.

Remember, your goal is to keep the team healthy and safe. Focus on a safety and security plan which addresses likely safety risks. Safety risks the data call out as important.

Spending time on a plan which makes you feel better but ignores the remediable risks associated with the car is wasted money. Instead I suggest you spend the time to evaluate where your traveling employees are most vulnerable on the road. Find ways to improve the safety of their transportation.

If you do that you will keep the team safe and spend money in all the right places.

It’s time to start re-evaluating your travel policies. What can you do to improve the safety and security of your traveling employees?

If you need help evaluating your current travel safety plan feel free to contact me. I’d be glad to help you figure out what makes sense for your organization.

Step-by-Step Guide: How a Doctor Prepares for Travel to China

Do You need vaccines for china?


Hey mom, come on over and visit me. We can go out and see some of the countryside during my vacation.

Who could resist the invitation?

So for the last few months I have been planning my ‘big vacation’ to visit my son who lives in China.

This raises the question, how does a doctor prepare for a trip to China? Exactly how do I plan to stay healthy and enjoy myself?

Everyone says check online. But usually you get one-size-fits-all advice, which really means one-size-fits-none advice.

For example, if you check with the CDC they have a laundry list of all sorts of vaccines and health conditions to choose from. It’s a dizzying array of vaccines and health conditions to worry about. But they don’t actually tell you what you need.

You are left wondering, what from that big list actually applies to me? That can be a bit tricky to discern.

What I share here is specific to my exact travel plans and my personal health. I’ll show you my thinking and strategy so that you can understand how I plan to stay well when traveling.

Which strategy is best for you will depend upon your underlying health and your exact itinerary. What is appropriate for me may not be appropriate for you. It’s best to check with your own doctor to see which of the many CDC recommendations apply to you.

Routine and Travel Immunizations

Adult Vaccines

Of course the first thing people think about is vaccines. I work in healthcare so all of my routine adult vaccines are up to date, including my flu shot.

I stay up to date because I don’t have time to get sick when I travel.

As they say in the healthcare business…common things happen commonly. That means protecting yourself against common germs with routine adult vaccines is the first order of business.

It would be disappointing to get sick just because you didn’t take time to get your shots. Your doctor can help you review this handy chart to help you get caught up.

Just to drive this point home- currently there is a large (57,000+ cases) outbreak of measles going on in China right now, so I’m happy to be protected. I certainly don’t want measles to be my souvenir.

Travel Vaccines

I already have my Hepatitis A & B vaccines but I need a booster on my Typhoid vaccine. Not every traveler to China needs typhoid vaccine, but I am going out into some rustic areas in the countryside, so it’s best to be protected.

I will not have exposure to the conditions that favor Japanese Encephalitis so I will pass on that vaccine. The CDC also mentions rabies vaccine. Instead of purchasing $1000 in vaccine (yikes) I will avoid animals and purchase travel health insurance (see below). I wish it were more affordable, since it’s such an effective vaccine.

Preventive Medicine

Blood Clots

Blood clots can be both uncomfortable and dangerous. I need to be careful since it is a long a 14-hour flight. I’ll be sporting anti-embolism stockings under my travel clothes. They are not stylish, but effective. In addition to preventing blood clots the stockings keep my feet from swelling, making it much easier to move around once we arrive.

Jet Lag

What am I going to do about jet lag? The last time I was in Beijing I was dragging the entire week.

This trip I’ll be off 12 hours from our home time zone. By my calculations we’ll be adjusted just in time to return and have the same problem again. Ugh!

I looked into several apps and online programs to help you switch your time zones. But although they are based on science, using light at the major trigger for resetting your internal clock, they are too cumbersome and too complicated to be practical for anyone who has to work before and after the trip

I’ll get plenty of sleep for the week before travel, so that I am not working on a sleep deficit, which always makes jet lag worse. Once I arrive, I have several very quiet slow days planned. That will allow me to get myself out into the sunlight as much as possible.

Using sunlight, especially in the morning and evening, to reset my internal clock along with melatonin at bedtime should help reset things as quick as possible.

I’ll definitely be dragging for a few days. Fortunately I’ll be a tourist; it won’t matter as much that I am foggy for the first week.

Treat Health Problems

Underlying Health and Medications

I am rather healthy, only suffering from allergies. Of course I’ll bring plenty of my regular meds. I’ll also pack some of over-the-counter products for upset stomach, skin problems, and pain relief.

Tummy Troubles

Because I will be in remote locations and eating in very small eateries I will bring along some antibiotics to self treat in the event of intestinal trouble. The best plan will be to eat hot, freshly cooked food and pure water. I want to bring antibiotics along so that I able to nip any tummy trouble in the bud before it ruins my travel plans.

Insurance Coverage

Travel Health Insurance with Evacuation

Travel health insurance with evacuation is the solution to so many problems. My health insurance doesn’t work outside of the USA. If I became ill or injured I would have to pay cash to get the medical care I need which can run well over $50,000. This type of travel insurance is very affordable, less than $65 for 2 weeks. It covers me for healthcare while abroad, including if I am bit by a potentially rabid animal or need an air ambulance home. It costs is far less than even a change airline ticket fee to come home for treatment. Hopefully, I’ll never need to use this insurance, but it brings me peace of mind to know this problem is solved.

The excitement is building as I get closer to my departure. I can’t wait to see my son.

It takes a bit of advanced planning to prepare for travel to China. Fortunately, it takes far less time to prepare to stay healthy than to book my hotels, transportation and activities. I have so many exciting excursions planned I don’t want to loose a single day to illness.

If you are planning on traveling to China it’s a good idea to get started now.

  • Start by reviewing the recommendations of the CDC.
  • Make plans to manage any chronic health problems such as asthma or diabetes that need to be controlled while you travel.
  • Allow enough time to get an appointment with your doctor to find out which health recommendations apply to you.

Of course, it takes some preparation but it’s really worthwhile. You don’t want to loose a single minute of your visit due to a preventible health problem. You’ll thank yourself when you feel well the entire trip.

How do you prepare to stay healthy while traveling? Please share in the comments below:

Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.


photo courtesy of tequillapartners

Can You Eat Healthy While Traveling for Business?

Italian chicken, with zucchini, beans and tomatoFirst in a Three Part Series:

How Tiny Efforts Create Big Wins When Eating Healthy on the Road.

Two weeks ago I while skiing at Steamboat Springs I realized how hard it is to stay healthy while eating out, even when participating in athletics.

My husband and I escaped for a long weekend to ski, relax and take in some wonderful film festivals at the Chief Theater in Steamboat Springs.

It was like skiing in a Christmas card- fresh snow, flocked trees and a clear blue sky. We were loving life and generally working up a sweat skiing amongst the beautiful trees. So we headed off to the mid-mountain lodge to see what was on the menu for lunch.

Fresh pasta, hand crafted sandwiches, and of course a grill with burgers and fries. Steve couldn’t resist a bowl of pasta Alfredo while I selected the wild Alaskan salmon sandwich on a gluten free bun with side of kale salad—it was Colorado after all!

I began eating. And eating. And eating. About halfway through the meal

I realize I couldn’t finish the sandwich.

I feel so guilty wasting all this food.
Steve reassured me, “Don’t worry this is Colorado- the land of zero waste they’ll just compost it.”

I realized I was suffering from portion distortion. Portion sizes at restaurants are enormous, 2-3 times what they should be. Everything has been super-sized.

Even in Colorado, land of the über fit and in-your-face health conscious self-appointed experts.

Where I live all the restaurants are judged by the size of their portions. People say ‘It’s a great restaurant…the food tastes good and the portions are enormous!’

Why don’t they ever say… .’the food is so tasty and the portions are right-sized’?

I am tired of having to figure out not only what do I want to eat but also how to manage the portions. Why can’t the restaurant give me the right size portions in the first place?

I’m still going to pay my bill. I’m going to tell others how delicious the food is.

Why over feed me so that I feel uncomfortable? Is that hospitality? Eat.. eat..eat until you are uncomfortable and well on your way to bad health?

OK so I know that I am the only one responsible for what goes on the fork and then into my mouth. But can’t you help me out a bit here?

Why put so much tempting food in front of me and then ask me to use so much energy resisting it. Why not just right-size it in the first place?

You eat twice as many calories if you eat out than if you eat at home.
But what if your job requires travel or business over meals? Are you doomed to becoming overweight and unhealthy? How can you eat healthy while traveling for business?

What can the traveler do?

Realize the days of the clean plate club are over. You no longer have to clean your plate at every meal. Instead, start using the divided plate concept at restaurants.  Basically you assemble your meal from basic building blocks to fit on a plate divided in quarters.

Developed by USDA. It’s so easy to understand even kids can do this. Just ask them, it’s part of the health curriculum at many schools. Click here 

The plate is an 8” plate, not the grand 12’-14’’ plate often found in restaurants and fancy dish sets. Use a luncheon plate. You can get plastic ones with cartoons on them at local stores. But even better you can carry this around in your head, without the actual plate.

How to build your divided plate:

Start with the protein. Pick a lean protein, not slathered in sauce. It should be 2-3 ounces. Even if you don’t know how big 2-3 ounces is it’s easy to remember since it’s about the size of a computer mouse. Your whole grain side dish or bread should be the same size (this may be only half a large bun or half of a bagel)

Then you add fruits and veggies to the second and third quarters.

Come on, I know that half of you aren’t eating any fruit, and fully one quarter of you aren’t eating any veggies today. Give it up. It’s time to change. And this plate technique can help you.

Make sure you add vegetables and fruit to be the same size as your meat and grains. You are supposed to eat as many fruits and veggies as meat and grains combined.

There you have it a plate fit for a king. A fit king.

When ordering at a restaurant it can be difficult to have everything arrive all on one neat little divided plate. I doubt they stock those cute cartoon plates anyway. :-)

BUT you can order a salad for your first course, or vegetable appetizer. You many need to hunt through the choices since some foods are a bit awkward to eat with business associates. Look over the menu, find something. It’s a good idea to have your server put the sauce or dressing on the side.

Then when your dinner arrives, trim your meat to the appropriate size. And DON’T pick at the remainder. Just eat your right-sized portion and leave the rest.

Remember, the clean plate club has been disbanded!

Steve and I quickly realized that all the restaurants in Steamboat Springs served up enormous portions of food. We had to find a solution. And so, we divided and conquered.

Instead of dividing our plates we divided our order to conquer the overwhelming portion sizes. I began to order one main dish and then split it between the two of us. This works well when traveling with a companion. Alternatively, you can split the meal when it arrives and put half in a to-go box. Now your meal is right-sized and the cooking for tomorrow is done too!

I was able to enjoy the meal without that uncomfortable overstuffed feeling. I maintained my weight throughout the week. Splitting an entrée might be a bit awkward with a client. But it worked for me when traveling for leisure.

How do you handle the large portion sizes offered at restaurants?

Share your ideas in the comments below.

Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.

What do Business Travelers Need to Know About Measles?

FeverIt’s been a tough day. Your presentation went well. Now you realize how exhausted you are as you melt into a seat at the airport pub and order a chicken sandwich. As usual, you begin to tap away at your phone catching up on emails. You just want to get on the flight and get home to your family when something catches your eye on your phone: A warning about a measles outbreak affecting all travelers at the airport.

Really? Do you need to worry about measles whenever you walk through a public space?

Yup, measles is the most contagious virus on the planet.

You can catch it just by walking through a place where someone with measles was, two hours ago.You don’t even need face-to-face contact with an infected person. Yikes.

But you only need to be concerned if your measles vaccine is not up to date. If you are properly immunized, relax you’re covered.

What’s the big deal about measles anyway?

Measles is rather nasty disease. That is why the vaccine was developed in the first place. Not only are you miserable, fevered, and have a pronounced rash, but 1 in 1000 people with measles go on to have a terrible brain infection and die.

That’s right, die, despite excellent medical care.

Collectively we have just forgotten how awful the disease is since we haven’t had a large-scale outbreak in the USA, until recently.

How did this happen?

In the late1990s a doctor in England faked medical data and abused developmentally challenged children for his own personal gain. He claimed that autism was related to the MMR vaccine. This has been rebuked by well-designed scientific investigation, but still he created doubt in the public’s mind.

This [false] doubt led to people being afraid to immunize their children. Which then led to a significant number of unimmunized people in Europe and the USA. This then led to the natural consequence of ongoing outbreaks in France, Spain, Wales and now the USA.

So now you, the busy business traveler, are exposed to hundreds of people when you travel, including those who might be infectious with measles. And you have no way of knowing who can make you sick.

Do you need a measles vaccine?

People without prior measles infection or 2 doses of vaccine need to get immunized. Now.

How can you protect yourself from measles?

The only way to protect yourself from this viral illness is vaccination. There are no medications to treat or prevent measles.

The first dose of MMR provides protection for 95% of people, and the second dose of vaccine provides protection for the remaining few. It takes two doses to provide reliable protection.

Who needs a measles vaccines?

  • Anyone born after 1957 who has never been vaccinated. There’s no time like the present to get caught up. You will need 2 doses of MMR at least 28 days apart.
  • Anyone who has received only 1 dose of MMR. If you graduated high school before 1990 you may not have received both doses of measles vaccine. Many adults in the USA are under-immunized because they received only 1 dose of measles vaccine as a child.
  • Anyone born between 1958 and 1967 . The original measles vaccine, which began in 1963 was different from the current MMR. It does not provide the right kind of protection. This is why we switched to the current 2-dose MMR vaccine.
  • Anyone who is not sure of his or her vaccine status. If you aren’t sure you have received both doses, go ahead and get protected. It is not harmful to get a third dose of MMR vaccine, but it could be very harmful to miss the second dose of vaccine.
  • Anyone 6 months or older planning to travel outside the USA who hasn’t received MMR vaccine.

Who shouldn’t get a measles vaccine?

  • Anyone born on or before 1957 is presumed to have measles immunity since all children in the USA got this infection. So there is no need to get vaccinated, you are already immune.
  • Anyone who has a problem with their immune system should check with their doctor. In some cases, you should not get the vaccine. If you can’t get the vaccine, be sure those around you do to protect you.
  • If someone in your household has an immune problem have them check with their doctor before getting your vaccine, just to be sure it is OK.
  • Surprisingly, most people with egg allergies can get the vaccine. If you have an allergy to eggs check with your doctor to see if you can get the MMR vaccine.
  • Anyone who is pregnant or planning on becoming pregnant in the next 28 days. Wait to get vaccinated after you deliver your baby
  • Anyone with a life-threatening allergy to neomycin.

A full list of do’s and don’ts and other information about measles vaccines is listed here.

For those with busy schedules, many pharmacies offer vaccines at convenient walk-in hours.

These are general guidelines. Always check with your own doctor to see if MMR vaccine is right for you.

Can I get a blood test to check on my vaccine status?

Yes a blood test is available to check for immunity. It is expensive and usually not covered by healthcare insurance. It’s primarily used for healthcare workers as part of pre-employment screening.

It’s actually easier and less expensive to get the measles vaccine. There is no harm in getting the vaccine if you are immune but didn’t know it. I mention the blood test for completeness, but it’s rarely used due to expense.

Bottom Line:

If you travel a lot, you will be exposed to measles since a significant numbers of people in Europe, Asia, UK and USA are not properly immunized.

Get yourself protected.

IF you don’t know your immunization status and were born after 1957 get a second dose of MMR. It’ll make you feel calmer, so that you can focus on your business and your life without worrying about outbreaks

Isn’t that what your really want anyway?


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What Can You Do to Avoid the Iceberg of Health and Safety Risks When Traveling Abroad for Business?


Travel vaccines. You don’t usually forget these when you go to a developing or exotic destinations.

They’re important; but they’re only the tip of the iceberg.

Lurking below the surface are a myriad of other travel-related health and safety risks, even in developed countries. If you don’t take precautions they can hurt you or your employees.

Here’s what I mean…

Several years ago I had the chance to watch icebergs form in a high mountain lake in Alberta, Canada.

I had hiked several hours through dry dusty chaparral to reach the crystal blue lake. At the crest in the trail a cool breeze swept me up and caught my attention. I could see white chunks of ice bobbing around in the water. Baby icebergs. Nothing like the one that sank the Titanic, but fascinating nonetheless.

But I was most surprised by what I heard: first a crack, like a shotgun in the distance. I didn’t see anything, but my senses tingled….something big was going to happen.

Then, a minute later, the deep boom. I felt as much as I heard it, rumbled through the valley as a block of ice the size of a car, broke off into the water.

It’s weird, but once the ice splashes into the lake you only see the very top, about the size of a driver’s seat. I knew the rest was there, I just couldn’t see it hiding below.

It’s that way with travel health too. What you need to know is more than you initially see.

Travel vaccines are just the tip. And the majority of what’s important is often hidden, out of view. It might even make you think that travel medicine is covered in routine healthcare.

But it’s simply not true.

Good travel medicine incorporates healthcare, safety, and security into one cohesive program {tweet}.

If you rely solely on routine healthcare to protect your employees you fail to consider how many different items need to come together to ensure safe and healthy travel. A good travel health program ensures you don’t miss the bulk of the problems below the waterline.

So why do only 10% of the 5.1 million Americans who travel abroad for business receive travel-related health care?

Organizations are either ill informed or short sighted. Some aren’t sure how to put an effective program in place. Others are hoping that nothing bad happens while their employees are traveling.

You need to know that as the employer you’re responsible for protecting your team the risks associated with business travel.


Plain and simple; it’s a workplace safety issue.

And it’s one that can be addressed with a comprehensive program.

Which issues should you address?

Well, to use the iceberg analogy we can start at the base and work:

At the base of is a commitment to overall health and wellness.

Many organizations implement a smorgasbord of health insurance, fitness, and stress-reduction programs. Currently a lot of research is being done to determine which programs are the most effective.

Oft overlooked, but truly foundational in a travel health program is sleep health.

Chronic poor sleep is associated with a wide variety of metabolic and productivity problems. For example, continuous nighttime sleep is essential for good weight control.

Jet lag contributes to sleep problems. Just switching as little as three time zones can cause you to function as poorly as if you’re intoxicated.

Your employees may be aware of their sleep problems but not quite sure how to fix them. Clearly, teaching them to solve those issues will help them be more successful at work.

The automobile presents the biggest safety risk to your traveling employees.

Different countries have different rules, lighting, and maintenance of their roads. Travel-related sleep deprivation and road signs in unfamiliar languages complicate these difficulties. Educational programs that focus on safe driving while abroad help your employees save lives.

Of course travel safety is more than automobile safety.  A comprehensive personal safety program is always a wise choice. The first step is to enroll in the Smart Traveler Enrollment Program (STEP) {link} and other programs by the US Dept of State. These are designed to keep travelers apprised of emerging security threats.

Health insurance carve outs are the ice caves in this model.

Many health insurance plans don’t cover out-of-country expenses like visiting the emergency room, medications, or require them to pay upfront and get reimbursed later.

If your employee suffers a heart attack or car accident they should be repatriated (brought home) for medical care. Air transport of ill patients can range from $10,000 to $30,000 and has to be paid up front.

A better alternative is a travel health insurance policy with coverage for evacuation. These are relatively inexpensive and a cost effective way to give you and your employees peace of mind while traveling. Your insurance agent can review the details with you.

Chronic health problems are like rocks in the iceberg.

They affect every layer of your program. When your team members travel with an underlying health problem they’ll feel as if they’re in vaguely familiar surroundings, quite comfortable until the cold wind of reality hits: a flare-up due to conditions at the destination. What will your employee do? It’s far better to address these issues with a pro-active treatment plan prior to departure.

Many travelers are unaware of the health consequences of travel, itself.

For example, did you know that blood clots can be caused by flights longer than four hours? And, if the flight is more than six hours, your employees’ risk rises substantially. Simple interventions can minimize these risks.

Near the water’s surface is education and prevention of locally acquired diseases.

Ebola has raised the world’s awareness that not all destinations are the same, and not all have the same healthcare infrastructure.

Surprisingly, travel to Europe, China, and South America have many unfamiliar problems that your employees need to address. Providing your team with destination specific advice is an essential part of a good travel medicine program.

Vaccines and medications form the tip of the iceberg.

As we near the top, specific concerns such as travel medications and vaccines pop above the surface for us to see. These are widely available from travel medicine specialists ({link ISTM} and local pharmacies.

To keep your employees safe, healthy and productive you’ll need a comprehensive travel medicine education program. One that addresses both obvious risks and the ones lurking below the waterline.

It’s worth repeating, travel medicine is a workplace safety issue.

When you provide your employees with the proper training, medications and vaccines to mitigate the hazards of travel you transform them into safe and healthy travelers; ones who understand the risks and why they should take certain precautions. And best of all, you help your employees become effective ambassadors for your organization.

Do you need help educating your employees about the health and safety risks of travel?

Give me a call, I’d be happy to discuss your specific needs.

Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.

Why You Need a Workplace Health and Safety Plan for Your Traveling Employees.

Workplace Health and SafetyDanny was admitted to the ICU.

That simple statement is how I found out you could get sick on the job. I didn’t know Danny well,  he was my classmate in medical school. So when he came down with an infection, one that he caught from a patient, it changed my whole way of thinking. Before that, it hadn’t really crossed my mind that you could actually get sick while working.

Nowadays everybody knows this. You hear stories about nurses and doctors dying after contracting Ebola from their patients. Daily we see photos of healthcare workers in protective outfits being sprayed with chlorine after caring for patients. Despite all the protective suits, gloves, and masks, two nurses caught Ebola from a dying patient in Dallas, Texas.

The Ebola outbreak has been a wake-up call to the world. We’re far more connected and interconnected than we realize. Germs take advantage of that. And despite the ubiquitous information on the Internet, in newspapers, and on radio talk shows, we are struggling to contain and treat the Ebola outbreak.

Believe it or not, there are actually more dangerous viruses out there. Take the Marburg virus outbreak in Uganda, for example. And there are many more common health threats scattered throughout the world, even in Europe.

Not every health problem is as dramatic as Ebola or Marburg, but most people are unaware of the health risks of traveling, especially business travelers. They see ‘out there’ as the same as here. And that’s simply not true.

Different environments along with variable levels of governmental and healthcare services create unfamiliar health hazards in different parts of the world. We’re naïve to think that everywhere is the same, just because humans live there.

Travel Health is a workplace safety issue.

Just as you’d provide goggles, hard hats, and safety training for hazardous conditions on the job, you need to provide vaccines, medications, and safety training for your traveling employees. {tweet this}

Of course specifics will vary depending upon the destination, (just as the specifics of handling hazardous chemicals would vary depending upon the chemical being used), so it’s a good idea to know the geographical challenges of each area you send your staff.

You already know you’re responsible for providing a safe workplace and educating employees about anticipated safety risks. Here are some common ways companies protect their traveling employees:

  • Provide vaccines against diseases
  • Provide needed medications
  • Educate staff on preventative measures

Since vaccines can’t prevent all illnesses, preventative medication (like malaria pills) may need to be provided.

Also there are plenty of health risks for which there are no specific preventative medication or vaccines, only preventative measures. For example, using specialized insect repellents to ward off insect bites known to transmit diseases.

Often overlooked, is the effect of travel on employees with chronic health problems. Travelers to Beijing can expect to be exposed to irritating pollution. But, if you have asthma or heart problems, this noxious pollution can cause a serious flare of symptoms.

By addressing the effects of travel on underlying chronic health conditions you can provide the safest work environment possible. For that traveler with asthma; medications can be adjusted prior to departure to minimize the effects of pollution or other known triggers.

Since over 50% of Americans have a chronic health problem, that may or may not be known to their employer—it’s a good idea to have traveling employees review their destination with their healthcare provider. This will provide an optimum experience, one with minimal disruption to workflow from an illness.

Travel health is also a workplace productivity issue.

A key member of your staff can be waylaid by illness by failing to anticipate common problems. This then slows down the entire team and even undermines the reason for travel.

Bill was showing clients around in Asia. They were inspecting manufacturing plants to determine whether to invest in them or not. Suddenly GI distress set in and Bill had to leave the meetings. He actually got on the next plane home in order to see his own doctor.

Because Bill didn’t know how to avoid potentially infectious food he got into trouble. He also had no idea how to treat himself (many common illness can be treated while you’re on the road), and he didn’t know any local doctors. In addition, he potentially exposed everyone on the plane and his family to the infection.

But worst of all, he left his employer and his clients in a lurch and potentially soured a business relationship. All of which was preventable.

How much better it would have been if Bill had seen a travel specialist prior to departing. He could’ve avoided the wrong food, been able to self-treat, or see a local doctor.

It’s expensive to send your team abroad. Why risk wasting your investment with preventable health problems?

Education is part of the plan.

It was a great day when Danny (my medical school classmate) returned to work. He’d been gone for about three months with his hospitalization and subsequent therapies.

While he was gone we were left in the dark wondering what had happened, and whether it could this happen to us,. We also questioned if there anything that could’ve prevented his illness? Frankly we were distracted worrying about ourselves instead of focusing on our studies.

Danny’s ordeal underscored a weakness in our training program: we didn’t understand the health risks of our job or what we could do to minimize the chance we could get sick.

You may have overlooked this in your training programs too; there’s far more to workplace safety than OSHA compliance. Giving your employees the information and tools needed to stay healthy on the job helps them stay focused on the task at hand instead of wasting time and effort worrying about their personal safety.

Why not embark on an education program for your traveling employees?

You can hold workshops or seminars to help your team understand why traveling is a big deal and how to stay healthy when on the road.

Once team members understand how their health interacts with travel-related problems, they can develop proactive plans to stay healthy and productive while on the road.

Your organization can also use webinars and online courses to provide core knowledge and share timely updates with your staff. If your team is spread by geography and time zone, on-demand mobile friendly online courses are a popular option; they allow folks to learn important information at times and places of their choosing.

At TravelReadyMD we help organizations who want their employees to feel better, stay healthy, and get more out of the workday when they travel. We’re happy to help you assess your educational needs and develop tailored programs. CONTACT US  to see how we can help your organization.

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 about 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?


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: