Missionaries and Traveling -a health overview.
By Gary Podolsky MD
This write up discusses common health problems abroad

Missionaries, as they travel the countries of the world, may be exposed to various hazards, illnesses, and infections. Each trip is different. Short term visitors need only take simple food and water precautions while long term expatriates have the same risk for certain diseases as the local indigenous people.

Many illnesses can be prevented through immunizations. Vaccines give immunity but do not cause disease. Unfortunately many diseases that there are not yet vaccines to prevent against, also coexist with the ones we can prevent, so travelers must still be careful about food and water as well as insect bites to ensure good health.
The types of vaccinations required for an overseas mission will vary widely depending on the location, time of year and activities planned. Short-term travelers will have a much simpler visit and will not need as many vaccines as some who will stay and work in the community.

It is recommended that prospective missionaries have their health reviewed prior to departure

Some important issues to review with your doctor prior to departure include: Having an annual physical to determine that you will be all right while away. This includes checking blood pressure, cholesterol and any other appropriate tests. It is very helpful to bring along copies of tests when away. For those with heart conditions a Photocopy of an ekg is very useful. Having enough prescriptions for the duration of your trip as well an additional amount in case you have an extension. Many drugs may not be available in other countries.
Women should have their annual PAP test before they go.

In general review any health concern with your physician will alleviate anxiety and uncertainty before your departure. A list of doctors in other countries can be found at www.istm.org and www.iamat.org/

Some commonly given vaccines and their descriptions include:

Tetanus and diphtheria
- these are severe illnesses that happen worldwide and everyone should get a booster every 10 years even if they are staying in Canada.

Polio - this is a viral illness eradicated from North America (but not the world) through routine vaccinations. Some people will develop inflammation of nerves leading to paralysis from a Polio infection. Travelers going overseas are recommended to have a booster with the IVP Polio vaccine.

Hepatitis A - a viral illness that is acquired through ingesting infected food or water. Hepatitis can make people very ill with an increasing mortality with advancing age. Travelers going to areas where it is present are advised to have an initial shot, which is good for 12 months. A booster shot given 6-12 months will increase the immunity for at least 10 to 20 years (likely lifelong)

Typhoid fever - is another food borne illness. Typhoid bacteria can make people very ill. The injected vaccine is good for 3 years, while the oral pills are good for 7 years.

Hepatitis B - Hepatitis B is a different virus that can cause Hepatitis. It is acquired through body fluids so unprotected sex, needles, or other exposures will transmit it. It is more contagious and kills more people than HIV. The vaccine is usually given in 3 doses at day 0, then 1 and 6 months later. Two doses are recommended prior to the trip. A series of three shots gives long lasting immunity. Hepatitis B is recommended for people spending an extended period in areas where Hepatitis B is common. The vaccine is very safe and despite claims there is no evidence to associate it with diseases like Diabetes, Multiple Sclerosis or Autism.

Yellow fever
- Yellow fever is an infectious disease transmitted by mosquitoes in South and Central America and Africa. It has a mortality of up to 50% and is greatly feared. Yellow Fever may be recommended for travel to certain countries due to risk or even required by some countries prior to entry. For up to date guidelines regarding Yellow Fever check with your local travel clinic. Other vaccines like Meningitis, Rabies, Japanese Encephalitis and others are given according to need. Many illnesses may be successfully prevented through taking medication. Malaria is an infectious parasite transmitted by certain mosquito species

Malaria - Anti-malarial medication (Chloroquine, Mefloquine, Doxycycline and Malarone) is taken before and after the trip to kill malarial parasites before they multiply and cause damage. Different areas of the world have developed Malaria with resistance to drugs. The appropriate drug should be given to travelers based on that area they are traveling to.
Unfortunately there is not yet one perfect drug for preventing Malaria and all of the drugs have some type of side effect although most are tolerated. Taking anti-malarial medication does not guarantee immunity and people may still catch Malaria. Anti-malarial prevents travelers from developing life-threatening Malaria. Anyone with unusual fevers even up to a year after should be checked for Malaria.

Traveler's Diarrhea -This is sudden onset diarrhea caused by enteric bacteria that have contaminated food and water making people very suddenly ill. Precautions towards eating 'safe' food may help but people are still known to get sick. Taking Imodium and Pepto-Bismol help control symptoms. We prescribe an antibiotic like Ciprofloxacin for travelers to take themselves if they wish, for self-treatment.
Medication can also be taken for the prevention of altitude related illnesses like High Altitude Cerebral and Pulmonary Edema The cornerstone of good travel medicine is prevention and preventative advice. Avoiding contaminated food or water and insect bites is one of the best ways of preventing problems.
Sometimes travelers will get sick despite the best precautions. We encourage follow-ups abroad through our Canadian Embassies who will help you to find medical aid. If still sick on returning, we will see you at our clinic to determine the nature of the problem and start treatment.
Travel medicine is a new and growing field of medicine. If you have any further questions you can contact us at: (204) 453-9107