When we think about Responsible Tourism, promoting respect for the cultures and the environment of our destination country come to mind. Health on the other hand, is the other component that is not often talked about.

Learning about the cultures, regional geography, languages, and customs is key to being a responsible traveler, as is informing yourself about the potential health risks at your destination. While we have the means to protect our health, we also need to be mindful of how our health status impacts the people we come across during our travels.

When it comes to travel, getting immunized against vaccine preventable diseases is not only for your benefit, but also for the locals you encounter abroad. At home you may not consider vaccination for yourself, but as a traveler, even if you are healthy, you risk being a conduit for infectious diseases.

Diseases that are considered eradicated or rare in our part of the world (polio, mumps, measles, meningococcal meningitis, yellow fever), are a serious concern for local populations where there are low vaccination rates and different immunity patterns. At home you may not be exposed to diseases because people around you are vaccinated (herd effect), but abroad - if you are not immunized - you risk catching an infection without exhibiting symptoms right away and unwittingly pass it on to someone who is not immune. Not to mention that if you do get sick, you also put a strain on already taxed local healthcare systems.

The recent H1N1 outbreak clearly showed us how infectious diseases leap from continent to continent in a matter of hours, not months or weeks or days. As travelers, we have the potential to bring over infections to places where there was little or no previous concern and we also bring them back with us, adding stress to our own medical system.

Like other infectious diseases, the spread of H1N1 also showed us how poverty plays a major role in health. Persons living in crowded conditions are more susceptible to contracting infections and fighting diseases is harder if you have little or no access to healthcare.

Judging on a recent poll by the Consumer Travel Alliance (CTA), many of us still have a long way to go to becoming responsible travelers. According to the survey of frequent travelers, 73% said that they would fly even if they had the flu. A similar survey done by TripAdvisor last Fall also found that 51% of respondents said they would fly with the flu to avoid the ticket change fee (getting trip cancellation insurance or checking the fine print of your airline's policy for reimbursements on flu and major illnesses may be part of the solution).

Sexually Transmitted Infections (STIs) are especially linked to travel. You've heard this before, but avoid unprotected sexual contact. If you are going to have sex with a stranger, use latex or polyurethane condoms consistently and correctly. Bring your own condoms from home. The spread of STIs, including HIV, is in part due to the proliferation of sex trafficking and sexual tourism.

As travelers, we not only have the responsibility to help prevent the spread of diseases, but we should also be aware of the health of tourism industry employees who take care of us. Too often, workers deal with poor and unsafe working conditions, long hours, and poor wages. For example, trail guides may face frost bite in cold environments, scuba diver instructors may get decompression sickness, and hotel room cleaners work long hours, often with no benefits. These conditions may put their health at risk and we can look out for them by encouraging them to seek medical attention.

The International Society of Travel Medicine (ISTM) publishes 7 Tips For the Responsible Traveler. Below are other groups promoting responsible and sustainable tourism.

• End Child Prostitution, Child Pornography, and Trafficking of Children for Sexual Purposes (ECPAT)
• International Centre for Responsible Tourism
• Sustainable Travel International
• The Sustainable Tourism Gateway

We've been getting many online inquiries from people who are getting ready for aid missions in Haiti. Emergency relief efforts are underway to help Haitians recover from the devastating earthquake of January 12.

Prior to the earthquake, Haitians were already struggling with access to health care, clean water, and proper sanitation. Only 11 percent of the population had access to water in their homes and the median life expectancy is 60 years. While the death toll continues to mount and survivors have to rebuild their lives, there is hope that reconstruction efforts can be done in such a way that Haitians affected by the earthquake will have universal access to proper shelter, food, and clean water.

So what do you need to look for if you are going to Haiti?
Malaria: Falciparum malaria (the deadly type) is endemic in Haiti. Malaria is present throughout the country, including urban areas. IAMAT recommends a Chloroquine (ARALEN) regimen in weekly doses of 500mg (300mg base). Start one week before entering the malarious area, continue weekly during your stay, and continue for four weeks after leaving the country. See the IAMAT World Malaria Risk Chart and How to Protect Yourself Against Malaria Chart for prevention and treatment information.

Typhoid, Hepatitis A, Diarrhea: These gastro-intestinal infections thrive in areas with poor sanitary and hygienic conditions. Prevention includes drinking purified water, eating well cooked foods, and peeling your own fruits. Vaccination against typhoid and hepatitis A is also highly recommended. Based on your current health status, consult your healthcare practitioner to see if you need a prescription for medication to prevent diarrhea. Click here for a full list of Food and Water safety risks in Haiti.

Hepatitis B: This viral infection is transmitted through infected blood products, sexual intercourse, or infected items such as needles or razor blades, and may cause severe liver damage. IAMAT recommends this vaccine for your protection. It is usually combined with the hepatitis A vaccine.

Tuberculosis: This air-borne infection caused by mycrobacteria is endemic in Haiti. IAMAT recommends getting a pre-departure TB skin test and to get re-tested upon your return home.

Dengue Fever: This parasitic infection is transmitted by the daytime biting Aëdes aegypti mosquito. IAMAT recommends taking anti-mosquito bite measures, including applying repellent containing DEET on exposed skin and applying permethrin spray or solution to clothing. Risk is present year-round in Haiti, although outbreaks usually occur from April to September.

Post-Traumatic Stress Disorder: Witnessing the devastation may have an impact on your mental health. Burn-out, stress, and trauma is common among aid workers. Click here for information and useful links on this issue.

Rabies: This viral infection is transmitted through the saliva of infected animal bites which affects the brain and the spinal cord, and may be fatal. IAMAT recommends getting the pre-exposure rabies vaccination (three shots).

See IAMAT's complete list of disease risks in Haiti. Unfortunately, we do not have medical contacts in this country at the moment. Your consulate or embassy should be able to help you find appropriate medical care.

If you are looking to donate to, or volunteer for, medical charities operating in Haiti, here is a list to get you started:

Doctors Without Borders | MSF USA

International Committee of the Red Cross

Médecins sans frontières | Canada

Médecins du Monde | Canada

Project Medishare

Partners in Health

For a list of reputable charities:

Information on donating to US groups

Information on donating to Canadian groups

You can understand the confusion. Similar name, different medical specialty.

Chances are you have heard these terms before, largely due to the prominence of low-cost, affordable international travel. But what exactly are medical travel and travel medicine?

Medical travel (also known as medical tourism, global healthcare, and health tourism), involves patients who seek health care abroad for a variety of reasons, including the high cost of medical treatments and long waiting times back home, their insurance plans do not cover certain procedures, or they want quick access to cutting-edge medical technology available in other countries.

Normally encompassing elective procedures such as cosmetic surgery, dental surgery, fertility or alternative medicine treatments, medical tourism is becoming increasingly popular for patients requiring life-saving procedures like heart or kidney transplants, as well as knee or hip replacements. Often, patients combine their medical care with vacation time, usually in warm-climate destinations.

Travel medicine (also known as travel health), on the other hand, focuses on preventing the spread of infectious diseases by travellers. This multi-disciplinary field touches on several medical disciplines including preventive medicine, emergency care, immunology, epidemiology, mental health, gastroenterology, and dermatology. A travel health practitioner is also knowledgeable of world geography, the health environment, and the socio-cultural customs of the traveller's destination.

The three components of travel medicine are:
The individual traveller: Your age, past and current health status, underlying chronic health conditions, budget for medications and vaccinations;
The risks: Your destination, visits to rural or remote areas, type of travel - business, adventure, leisure, long-term working assignment, epidemics and general health of the population where you will be visiting; and
The intervention: Vaccination and medication recommendations, general health advice, including food and water safety, and insect-bite prevention methods.

For many travellers, doing research on the health risks of your destination, visiting your doctor for advice, or going to a travel health clinic to get vaccinated may seem like a daunting task. Afterall, we intrepid travellers just want to hop on a plane and start our adventure. However, things that many of us take for granted or consider an inconvenience of international travel such as time zone changes, barometric pressure, or poor air quality, do affect our health and may lead to complications if you have pre-existing health problems.

It's not only diseases such as yellow fever, dengue fever, or malaria that should be of concern. Mental health, sunburns, traveller's diarrhea, heat stroke, traffic accidents, trauma such as falls or near-drowning, and prescription refills during travel are all in the purview of travel medicine. Depending on your health and risk at your destination, it is not uncommon for travel health practitioners to advise travellers to postpone a trip, change your itinerary, or not travel at all.

A recently published study of long-term travellers to developing countries is instructive. It is estimated that 50% get sick, 8% see a physician, 0.3% require hospitalization, 0.05% are evacuated back home, and 1 person dies.

Typically, medical travel also has three components:
Research: Finding the medical tourism provider and exploring the standard of care you will be receiving abroad, including whether the facility is accredited by a reputable third party and if the doctor speaks your language, is licensed and qualified for the procedure; and finding out if the the medications provided are legal and safe.
Communication: Providing your medical reports, your medical history, and your doctor's opinion; discussing the type of treatment and cost, duration of stay, including post-surgery care and follow-up mechanisms to deal with complications; and exploring if your insurance company will pay for post-procedure care if complications arise back home.
Legalities: Signing contracts, coordinating entry Visa requirements, organizing travel and accommodation logistics; finding out your legal recourse if your procedure goes wrong, including the malpractice and patient protection laws of your destination country.

In this fast growing industry - approximately 750,000 U.S. patients travelled abroad for medical procedures in 2007 with projections of 1.6 million by 2010 - more companies are now offering full medical travel packages helping patients find the appropriate medical facility and doctors, including arranging travel and accommodation. Some insurance companies are also starting to venture into the medical tourism field. However, concern over medical liability and malpractice suits abroad means that medical travel patients continue to incur out-of-pocket expenses for their procedures.

Medical tourism and travel medicine cross paths when medical travel patients are exposed to infectious diseases during their stay abroad. Depending on your health status, you may be at higher risk of contracting an infection such as antibiotic resistant MRSA (Methicillin-resistant Staphylococcus aureus), hepatitis A, typhoid fever, influenza, or even tuberculosis - diseases that are uncommon back home, but are endemic in other countries.

Popular medical tourism destinations such as China, Brazil, Costa Rica, India, Malaysia, Mexico, Panama, and Thailand, for example, all have malaria risk in certain regions of their country. If you are considering doing sightseeing in the surrounding area, it is prudent to know what risks you may encounter. Moreover, whether you are convalescing in a state-of-the-art facility or not, like any traveller, it's important to consider the food and water safety of your local area since your body needs to adjust to the new environment.

Medical travel, travel medicine, or not... International travel has social, economic, and political implications on local populations. If you are a traveller seeking medical care abroad or if you become ill during your trip, your health status impacts the local health care system. Being a responsible traveller means being well prepared, weighing the risks involved, and leaving the smallest footprint you can behind.

Are you planning a trip to the jungles of South America or doing extended hiking and camping in Central America? You may be at risk of Chagas' Disease.

Transmitted by the Triatoma insect, which typically bites its victims on the face at night, the Trypanosoma cruzi parasite enters your bloodstream and affects organ tissues, most commonly the heart.

Found in forest ecosystems and poorly built homes, including huts and cabins, the Triatoma insect is commonly known as 'vinchuca' in Spanish or 'barbeiro' in Portuguese. In North America, we know it as the 'assassin bug' or 'conenose bug', but here it does not carry the disease.

According to the World Health Organization (WHO), Chagas' Disease affects between 16-18 million people. The disease largely spreads with the rise of migration to urban and suburban populations and increasing deforestation. Many countries in the region now have active health education and eradication programs (Chile and Uruguay have been declared free of Chagas' Disease. Although the Triatoma insect is still present in these two countries there is no evidence that the insect is continuing to transmit the parasite.)

Approximately 10% of persons infected with Chagas' Disease experience an acute phase, but for most it is a silent infection showing up many years later often mimicking chronic heart conditions, or as gastro-intestinal complications.

If you are staying in low standard accommodations, use a bed net to protect yourself (IAMAT sells LaMosquette, a light, free-standing - no ceiling hooks required, permethrin treated bed net). Make sure you thoroughly check the room (behind picture frames, along baseboards, and in furniture cupboards) for any evidence of the insect. You may also want to spray the room with insecticide.

For more information about the best prevention methods as well as the transmission patterns and geographical distribution of Chagas' Disease, see When Hiking Through Latin America, Be Alert to Chagas' Disease.

We have just added 3 new clinics to our Medical Directory. We are very pleased to welcome into our network the following doctors who are committed to helping travellers.

• Ankara, Turkey (2 locations)
  Bayindir Hospital Kavaklidere and Bayindir Hospital Sogutozu
  Prof. Levent Doganci, MD
  
• Oslo, Norway
  Reiseklinikken - Oslo Travel Clinic
  Dr. Gunnar Hasle, MD, CTH
  
• Sippy Downs, Australia
  TCA / Travel Clinics Australia
  Sandra Peters, BChB, CTH
  

Keep checking our Blog for new additions to our Medical Directory before your trip. Our online version is always being updated with new additions and contact information changes.

IAMAT Staff

Angeline (right) and Winona (left).
We recently met up with Dr. Ye Wei (Winona) and Dr. Meng Jing (Angeline) to talk about their two-month internship at Kaiser Permanente's Koolau Clinic and Honolulu Clinic in Hawaii. The two medical practitioners from China were each awarded a scholarship through our International Travel Medicine Education Program. The fund, which is solely supported by the generous donations of IAMAT members, has given 13 scholarships since 2002.

Chosen for their leadership skills, the two doctors will return home to teach their colleagues the skills they have learned in Hawaii, improving travel medicine practices in their workplace for the benefit of ill travellers.

The art and science of travel medicine
During the two-month intensive training program, Angeline and Winona are immersed in all aspects of pre-travel advice, travel medicine diagnosis, and post-travel consultation.

When asked what interests them most about travel medicine, their enthusiasm is inspiring. At the heart of their work is cultivating the relationship between caregiver and patient, ensuring that travellers are well informed to prevent the spread of infectious diseases and ultimately having a safe and healthy trip.

For Winona, who works at the Shanghai International Travel Healthcare Center, travel medicine is a multi-disciplinary subject. "Not only does it deal with medical and diagnostic aspects, but I have to be knowledgeable in world and regional geography, local climate, cultural and societal differences, legal requirements regarding medication and vaccination for the patient's destination. Providing comprehensive travel health advice to travellers is an art."

"No two consultations are exactly the same," adds Angeline who likes the diversity of her work. The challenge is to provide individualized recommendations for each traveller and keeping up with the latest in the constantly evolving field. "It's really important to keep up with up-to-date concepts and practices if you want to improve yourself in this field," she notes.

Getting the scholarship gives her the chance to kick-start her professional career in the field. A doctor at the Sichuan International Travel Healthcare Center, Angeline hopes to expand her scope of knowledge and share it with her colleagues and as many travellers as possible. "Since I am a novice in the field, the IAMAT scholarship has promised me a good beginning and I think that I'll have a bright future in travel medicine. I am so lucky to have IAMAT as a guide from the very beginning of my training. People always say that having a good beginning is already half the battle."

Winona says that for her, the internship is an opportunity to expand her qualifications and further promote travel health in China. "I have worked at my Clinic for almost eight years as a doctor and becoming a IAMAT scholar gives me the chance to go outside of China to increase my understanding of travel medicine." She tells us that through her background in immunology, she's interested in vaccine recommendation principles, specifically how they apply to different age groups and a patient's past and current health status.

Helping international travellers
Travel medicine is a relatively new discipline in China and is coming to prominence in large part to the economic reforms that have drastically increased the country's incoming and outbound international travel. Since 1995, IAMAT has been instrumental in advising the country's travel medicine and health network, the Chinese International Travel Healthcare Association (CITHA), develop and improve travel medicine practices among their clinics.

Says Angeline, "One of the first things I will do after I return is to share my experience with my colleagues and make as many people aware about the importance of travel medicine. The majority of Chinese people have not heard about travel medicine, so going for a pre-travel consultation to protect themselves is obviously not on their list." Her clinic will also start offering post-travel evaluations to Chinese nationals returning home after long-term working assignments in countries like Zimbabwe or the Democratic Republic of Congo where they are at high risk of contracting infectious diseases such as malaria or yellow fever.

A key component of IAMAT's scholarship program is to promote cross-cultural exchanges of medical knowledge and practices. It offers a chance for our scholars and their Hawaiian colleagues to exchange ideas and developments in the field practiced in their respective countries.

Training in Hawaii is a good opportunity to brush-up on their English speaking and writing skills. Says Angeline, "Having good communication skills, especially with someone of different education and cultural backgrounds is important."

A typical day at the clinic
The two interns have a busy schedule. Training takes them to the Koolau Clinic three times a week and to the Honolulu Clinic twice a week. Their day starts at 8:00am and usually ends at 5:00pm, in addition to studying in the evenings. Their supervisors, Dr. Vernon Ansdell and Dr. Johnnie Yates provide them with information about the patient's travel destination and health status the day before the client comes to the clinic, that way they have time to prepare their cases.

They also participate in the actual patient visit and provide advice based on their prior research and discussions with their colleagues. They are also given hypothetical cases to study and present the best approaches based on the patient's needs. "Through self-directed learning, discussion and problem-solving I can understand and master the key points of a specific case," says Angeline.

For her part, Winona enjoys the face-to-face consultations with patients, especially meeting new people and learning about their destinations and reasons for travel. Seeing how their colleagues interact with their patients is refreshing. "They are so warm-hearted and sincere with their patients, like old friends," notes Winona. The professionalism and physician-patient interaction is one aspect of her training that she'll take back to China to teach her colleagues. Adds Angeline, "The consultation part is neat, because face-to-face communication is direct and flexible. You don't know what patients will ask you or tell you, but you are the one leading the conversation."

The internship, however, is not all about studying. Both Winona and Angeline take the time to learn about Hawaiian culture and do sightseeing on weekends. They recently visited Diamond Head volcano and are planning to do some snorkeling soon. Being away from home for a long time can be hard, but both women keep in touch with their family and friends through online video-chatting. Winona, who has a five year-old son, Wang Ye Da, also writes about her overseas experiences on her Blog (in Chinese). "The people at the Clinic are so nice, so friendly, and they help me a lot, such as picking me up to go sight-seeing and going to restaurants to eat local specialties. I'm not lonely."

Photo credit: Vernon Ansdell

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

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

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

Here are the details:

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

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

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

We often get asked about the merits and pitfalls of travel health insurance here at IAMAT. Distraught friends or family members of hospitalized travellers who are not insured call us inquiring about last-minute evacuation plans, others ask us whether they should get travel health insurance. Many also contact us to tell us about their frustration with their travel health insurance policy, mainly for what it doesn't cover.

When we first started 49 years ago, travel health insurance did not exist. Nowadays, the travel health insurance sector is a multi-million dollar industry with hundreds of companies and brokers, including web-based ones, who specialize in this kind of coverage.

Weighing the risks of the type of travel you will be doing, your current health status, whether your destination has good and affordable socialized medical care available for non-residents, or even if you can afford insurance, are key issues to consider. Most importantly, do you have access to the name and contact information of a qualified physician at your destination whom you can trust? Keep in mind that if you require emergency care abroad, many hospitals and medical facilities cannot admit you if you do not have insurance coverage or proof of the funds available to pay for your care. Invariably, as a non-resident, your choices may be limited and costs can be exorbitant.

Getting the right coverage for you

If you decide to get travel health insurance, the best advice we can give is to thoroughly research policies and to read the fine print. Start by reviewing your medical insurance policy, employment / retirement benefits package, or your credit card company contract since you may already be covered. Check if it includes the following criteria:

• The insurance company either pays for emergency hospital or medical costs up front or reimburses you at a later date.
  
• Allows for cash advances if the hospital or doctor requires immediate payment.
  
• Covers you for a pre-existing medical condition such as diabetes, heart or kidney disease, or cancer, as well as premature births and emergency neo-natal care.
  
• Provides an in-house, emergency hotline available 24 hours, 7 days a week from anywhere in the world with operators who are multilingual, and have nurses or doctors on staff.
  
• Provides medical evacuation services back to your country and pays for a doctor, nurse or paramedic to accompany you during the trip.
• Pays for the preparation and repatriation of your remains in case of death.
  

If your existing coverage does not adequately cover you for the purpose of your trip, you will need to get supplemental travel health insurance. Your broker, travel agent, bank, drugstore, or local automobile association will often provide you with coverage or direct you to the right insurance carriers. You can also search for companies on the internet by typing keywords such as "Travel Health Insurance", "Medical Evacuation" or "International Medical Insurance Coverage".

Do your research, get quotes, and ask questions

As you research and get several quotes on policies, you'll need to be attentive to details. For example, one company may have different definitions for the same terms used by another carrier. Moreover, each policy has different standards on length of coverage, medical exemptions, deductibles, co-payment rules, refund policies, and the cost of the premium you'll have to pay to access their medical services abroad.

Coverage is for emergency care only. Typically, policies deal with ground and air ambulance transportation, hospital in-patient care and medication, outpatient services, doctors' fees, and travel expenses related to the emergency. Insurers will not pay for routine check-ups, non-emergency care, or cosmetic surgery.

Your age, medical history, current health status, length and cost of trip, distance of your destination, and country determine the type of coverage you qualify for and how much it will cost. You'll find that there are many exceptions that insurers consider prior to approval. For example, insurers may not pay for emergency care related to your pre-existing conditions (diabetes, cataracts, cancer, heart conditions, kidney disease, surgery, stroke, or psychiatric disorders). If you end up suffering from a psychiatric problem with no previous history of mental illness, your claim may be denied.

Incidents related to alcohol or drug use or injuries sustained by extreme sport activities such as rock climbing, mountaineering, bungee jumping will not be covered. If you are pregnant or have AIDS most carriers will not cover you. If you are taking medication, and your doctor changes your medication for a health problem within 90 days, six months, one year or longer of your application, you may not be covered. Most carriers will not insure you if you go to a country where your government has issued travel advisories, such as a region affected by war or political unrest.

It is important to clarify any terms or questions you may have. If they are not answered to your satisfaction, get more quotes. Don't forget to check with your local Better Business Bureau branch or the national association of travel health insurers to see if the carrier you are considering is a reputable company.

Roles and responsibilities

Find out what your responsibilities are and carefully read what your insurance company will and will not do. For example, insurance companies set time limits for coverage and hospital stays, so if you are going on an extended trip find a carrier that will respect your timeline. If you require to be evacuated make sure your policy stipulates that you get to return home, not brought to the nearest medical facility where often care may be limited. Also, find out how many family members can be claimed under your policy or if your travelling companion(s) are also covered.

How does the claims process work? Will you have to pay for medical costs upfront and get reimbursed at a later date, or will the insurer pay the health provider immediately? Depending on the policy, you will have to pay a minimum deductible towards your claim, even if the claim is less than the deductible. Moreover, you may be responsible to pay for a percentage of your medical costs, generally between 10% to 20%. Carriers usually are not responsible for reimbursing the full 100% cost of your healthcare bill.

If you do apply for travel health insurance do not lie about your medical history. A future claim will be invalidated and leave you without emergency care or out of money for expenses incurred abroad. You may be tempted to get the cheapest coverage available, but keep in mind that in the end you'll find that the coverage will be limited and you may be left responsible to pay for costly medical services.

The importance of being prepared

Remember to bring your insurance policy with you during your trip and give a copy to a relative or friend who is not going on the trip with you, just in case they need to contact the insurance company.

Travel health is all about prevention and common sense. Being aware of health issues that may arise and taking the appropriate measures to prevent illnesses and accidents when you are travelling are key components to enjoying your trip. If you are going to a region where IAMAT does not currently have an affiliated clinic or hospital, consider getting travel health insurance. The least you can do is register with your government (Consulate or Embassy) prior to departure so that if you do require emergency help they will be able to coordinate the appropriate medical care.

The World Health Organization's recent A(H1N1) Influenza pandemic declaration is no cause for panic.

It is important to keep in mind that the WHO's upgrade to Phase 6 is strictly based on the geographic spread of the infection (the virus is currently making its way throughout the southern hemisphere as part of their normal flu season) rather than the number of infected people or the severity of the symptoms.

Here's what public health officials currently know about this new strain of the A H1N1 virus (also known as human swine flu):

• Human-to-human transmission occurs through infected cough or sneeze droplets either inhaled or by touching a contaminated surface.
• The majority of infected persons experience mild symptoms and fully recover, usually without the need for hospitalization or medical care.
• The virus seems to infect younger people, usually under 25.
• A majority of severe cases and fatalities occur in people (30-50 years old) with underlying medical conditions such as diabetes, asthma, heart disease, auto-immune disorders, and obesity. Pregnant women are also at higher risk of experiencing complications.

What we do not know is how the virus will act or mutate over the next few months, especially as the second wave of infection will occur in the northern hemisphere this Fall. It is also not clear to which extent this viral infection affects people living in poor socio-economic conditions (crowded housing, chronic health problems) who have limited or no access to good healthcare.

There is still no vaccine against this virus. However, Swiss-based pharmaceutical company Novartis has just announced that it has produced the first batch of A(H1N1) vaccine and that it plans to start clinical trials in July and expects the vaccine to be available this Fall.

If you are travelling, it is always important to practice good hygiene, regardless if there is a pandemic:

• Wash your hands frequently and thoroughly (15-20 seconds with soap and warm water). If you do not have access to water or soap, use an alcohol-based hand sanitizer.
• Cover your sneezes and coughs using a tissue, or if you don't have a tissue handy, use your elbow sleeve. Properly dispose the tissue and wash your hands.
• Drink lots of fluids, eat healthy food, manage your stress, exercise, and get regular sleep.
• If you experience flu-like symptoms during your trip, seek medical attention immediately. See our Medical Directory online to access a IAMAT doctor overseas. If IAMAT does not have an affiliated clinic where you are staying, contact your Embassy or Consulate.

For more information:
World Health Organization A(H1N1) World Map

We are very pleased to welcome 3 new medical clinics to our network. Travellers to Lima, Québec City and Washington, DC will get quality medical care from the following IAMAT affiliated doctors:

• Kenneth H. Chase, MD of Washington Occupational Health Associates in Washington, DC.
• Christian Fortin, MD, MPH of Santé Millénia in Québec City.
• Hugo Siu, MD of Clinica Anglo Americana in Lima.

Keep checking our Blog for new additions to our Medical Directory before your trip. Our online version is always being updated with new additions and contact information changes.

IAMAT Staff