Abstract

Introduction

Working with wild animal patients within indigenous ranges is a true reward. This may require travel to distant and remote locations. A repertoire of survival skills is necessary to ensure a productive and healthy experience. The recommendations described are most appropriate for short-term stays in tropical environments. Travel need not be fraught with danger if common sense and basic health and diplomacy skills are exercised. Take it easy initially, dress lightly, and beware of jet lag, heat, and humidity. You should allow yourself a few days to adapt to local time zone and climate before launching into the field. You have all your vaccines and your first aid kit is ready. Now go out and fulfill the professional duties that your project requires.

Clothing

Clothing must fill many requirements. It must be adequate for temperature and climate conditions, provide protection from sun and insects, be easy to clean, lightweight, and have a versatility from smart casual to field use. Light colors are preferred. International weather reports are available from many web sites operated by international news agencies. Do not forget something smart; men should have a blazer and tie, and women a long dress in the event you are invited to a formal function. Clothing must be sensitive to local religious customs. Dress down to avoid attracting attention. Keep jewelry and other expensive items to a minimum. Do not wear flesh-exposing clothing in a Muslim country. Always carry a hat and a lightweight raincoat; a Gore-Tex® windbreaker is ideal.

Diplomacy

There are a few basic rules about diplomacy and meeting people. Remember that you are a guest and must behave as one. Be polite and pay attention to local customs. Attempt to learn names quickly and use a greeting in the local language. When meeting people always shake hands or perform whatever greeting ritual is appropriate with each individual. In many cultures, this is very important.

Do not discuss local politics. During your stay you will certainly not understand enough of the intricacies of the issues to have an informed opinion. You risk permanently insulting someone. In addition, involvement in politics in some countries is a ticket to trouble with local law enforcement. However, politics of your home country or region will be fair game. Try to steer away from emotional issues. Two other subjects that should be avoided are religion and sexual practices. They very quickly become problematic. There are many other safer subjects that can be discussed.

Learn about the country before you go. Get a guidebook and study it, especially the chapters on culture, customs, and history. However, once you arrive in the country do not use the book in public. A stranger reading a guidebook on the street is a sure target for crime.

Visas

For many countries a visa is required to enter. Requirements and types of visas vary greatly. First of all verify that your passport is valid. (Do this now!). Hopefully your hosts will arrange for the official paperwork but you should check with a consulate yourself to avoid surprises. Apply for visas well in advance as they take time. Prepare a set of passport sized pictures.

Work Permits

You may need additional permits such as work or veterinary permits if you are working in an official capacity. These requirements are hard to find and difficult to fulfill. Your local contacts need to investigate these aspects and you need to push them to do it. You may be covered under the umbrella of local veterinary counterparts but this needs verification. Bring copies of your veterinary degrees and licenses. The more official paperwork you can present the better your chances of success. Some countries require this to be done before arriving. On the other hand, sometimes you may enter the country as a tourist and then arrange permits.

Sample Import/Export

To move samples between countries requires advanced preparation to cover the legal and disease aspects. Each country is different. You will need CITES or wildlife and veterinary permits from the exporting country as well as the importing country. First apply for the import permits from your wildlife and agriculture authorities. Be advised that they can take up to 6-9 mo to acquire. Some universities or government organizations have blanket permits and they can assist with importation. Export permits can be acquired in the host country when an exact count of the type and number of samples is known. Plan to spend some days in the capital city chasing the permits. Some specimens such as primates may require additional permits from the public health sector such as the Centers for Disease Control and Prevention (CDC) in the United States. If you are told that no permits are required, get an official letter to prove this point, as the airport personnel may not know the regulations. Be familiar with all the important diseases and international treaties as you may have to explain the regulations.

Sample Transportation

Transportation of samples on commercial airlines requires knowledge of the regulations. The International Air Transport Association (IATA) publishes a list but airlines may interpret these differently. It is easier to bring samples as your personal luggage than by airfreight. Airfreight is expensive and there is a limit on dry ice volume allowed per aircraft. Liquid nitrogen is allowed on commercial aircraft provided it is in a "Dry Shipper", however have a copy of the appropriate IATA or U.S. Department of Transportation regulations to prove that to airline personnel. Formalin is generally not allowed due to its carcinogenic potential. The international standards for shipping of hazardous medical samples should be adhered to. These include screw-capped vials with labels written directly on, double, sealed plastic wrapping, with absorbent material of sufficient quantity between the plastic layers. All this is sealed in a metal can. Paint cans are ideal and available in most countries. Check with your airline, however make sure to connect with a knowledgeable person of authority. Recheck the information several times and best of all, get approval in writing.

Driving

If you need a vehicle insist on having a driver or use taxis. Driving customs differ greatly. Renting a car in a strange country is not a good idea until you have gotten your bearings. In many countries, traffic accidents, particularly those involving a fatality, requires that all parties go immediately to jail while the investigation takes place. You should not be the person going to jail. Nevertheless, get an "International Driving Permit" before you leave as it may come in handy. In the United States they are available from the American Automobile Association (AAA).

Political and Civil Unrest

This is always a difficult judgment. Being caught in riots or worse types of violence is very dangerous. News programs must be watched and developments followed. There will be large amounts of readily available and sometimes contradictory information. Disinformation, exuberant over-reporting and indirect news channels add to the confusion. Local people may give more accurate appraisal of situations on the ground and should be contacted. If minor trouble occurs, stay off the street and away from gatherings of people. Find out if the trouble is isolated or widespread and plan your travel routes accordingly. Have an experienced, local driver/guide who knows all routes and angles. If major trouble occurs contact your embassy for their instructions. It is a good idea to call your embassy when you arrive to inform them of your presence, particularly if you are going to remote areas.

First Aid Kit

There are many commercial packs available with adequate contents for basics. For foreign tropical destinations include additional disinfectant for wounds, an ample supply of any required medication, your favorite medication for cold, flu, and headaches, sun cream, mosquito repellants, bismuth compounds, loperamide, oral rehydration salts, and the anti-malarial of your choice. You may consider bringing a 3-day course of an antibiotic such as doxycycline or a fluoroquinolone. Your first aid kit is a balance between functionality and portability. The size of your kit depends on the size of your expedition and the remoteness of your destination. Anyone with pre-existing health conditions such as diabetes, cardiovascular, renal, hepatic, or gastrointestinal diseases should discuss the implications of jet lag, change in climate, and access to medical care with their physician.

If you require medical care while abroad go to the best facility available. Embassies, hotels, and travel companies have lists of local medical staff who speak multiple languages and/or are familiar with the problems of travelers. Watch the needles and syringes to ensure they come from sterile packaging. Blood transfusions and surgery should be avoided unless necessary to save life or prevent serious morbidity. Emergency medical evacuation insurance such as International SOS is available in most parts of the world and for short-term travel it is a good idea.

Malaria

Foremost comes the issue of malignant malaria as 1% of non-immune patients with Plasmodium falciparum die. There is a choice of prophylactic antimalarial drugs, which you most likely must start before commencing the trip. Be aware that endemicity varies with location and season. The World Health Organization (WHO) provides a good country-by-country overview with recommendations for appropriate therapy. Many government health services issue recommendations as well. You should check several sources of current information as disease incidence and opinions are always changing. Unfortunately no antimalarial prophylactic regimen gives complete protection and no drug is devoid of adverse reactions.

Prevention from infection is the current trend. Mosquitoes bite from dusk to dawn, so stay inside at night and use insecticide impregnated bed netting for sleeping. Wear long sleeves and long trousers if you are outside. Use N,N-diethyl-meta-toluamide (DEET) insect repellant as it is the best. Purchase a brand with the highest percentage of DEET possible. Preventing insect bites will also prevent transmission of dengue, filariasis, leishmaniasis, onchocerciasis, trypanosomiasis, and Rift Valley Fever.

If failure strikes and you are far from civilization have standby treatment in your medical kit. Severe flu with a headache is suspicious particularly with a fever starting after 7 days of exposure. Start treatment within 24 hr. In cases of failed chemoprophylaxis against multiple drug resistant P. falciparum, use quinine and tetracycline, mefloquine (Larium; Roche), or a sulfa/pyrimethamine combination (Fansidar, Roche). More recent entries to the antimalarial arsenal are artemether-lumefrantine (Riamet; Novartis) and atoquone-proguanil (Malarone; Glaxo Wellcome).

Vaccines

A series of vaccines will be necessary for safe travel. An International Certificate of Vaccination should be carried together with your passport. They are available from most medical clinics that specialize in travel medicine. The International Society of Travel Medicine has a listing of over 500 travel medicine clinics. Have your diphtheria/tetanus, rabies, and polio coverage checked. Yellow fever is needed for entry into many countries. Other vaccines are hepatitis A, hepatitis B, typhoid fever (oral), and meningitis A + C. Japanese encephalitis vaccination is advised in Asian countries. Cholera vaccine is not recommended due to poor efficacy. Start early on vaccines in order to recover and have good immunity before travel.

Heat

Beware of the adverse effects of heat. Heat exhaustion is caused by water depletion via sweating and diarrhea. The patient will be thirsty with scanty, concentrated urine. Sweating without salt replacement causes salt depletion. The patient is generally not thirsty and the urine is low in NaCl. Heatstroke is shown by an excessively high body temperature. Prickly heat is caused by high heat and humidity combined with friction from clothing. Treatment of all of these is similar. Get to a cool location, replace water and/or salt orally or intravenous if necessary. Take cool showers, drying the body thoroughly and apply calamine lotion to treat prickly heat. Above all prevent these condition by consuming plenty of fluids, adding extra salt to food, and dressing appropriately.

Diarrhea

Being careful with food and drink is the best method to prevent diarrhea, however some diarrhea is inevitable due to changes in gastrointestinal microorganisms. There are over 50 causes of acute diarrhea. If it is not serious then stay home and stay hydrated until it passes. Use a combination of tea, soda, clean water, juices, or oral rehydration salts to push fluid intake. If oral rehydration salts are unavailable, adding 6 teaspoons of sugar and 1 teaspoon of salt/L of clean water can make a temporary substitute. If important tasks need to be completed that day then loperamide may be used with discretion. Serious diarrhea combined with blood in the stools, high fever, abdominal pain, or depression should be immediately investigated by a physician. Bismuth subsalicylate (Pepto-Bismol, Proctor & Gamble) taken one to three times daily has been effective in preventing diarrhea and is an option for short trips.

Food and Water

All water should be boiled at least 10 min before use. Use only suitable drinking water for dental use. Beware of ice cubes. Bottled carbonated beverages are usually safe. Bring your own methods of making clean water as you may be far from a store or it may be late at night when you need water. There are numerous portable filters on the market. Make sure that you have one capable of removing virus particles. Look for an "absolute 1-micron or less" filter. Ceramic and charcoal filters are not sufficient. Water purifying tablets based on iodine or chlorine are a quick water treatment. Bleach at 10 drops/L for 30 min or 2% tincture of iodine at 10 drops/L for 30 min can be used to sterilize water. Double these concentrations if the water is cloudy or cold.

Avoid any food that is not well cooked and served to you hot, or fruit that has not been peeled yourself. Salad is dangerous. Raw milk products should also be avoided as brucellosis and tuberculosis are common. Generally, major hotels or tourist centers are aware of the need for clean food and water. You can be slightly less careful in these locations. As one goes off the beaten track the more vigilant one needs to be. Remember: boil it, cook it, peel it, or forget it.

Post Travel Health

Upon your return be aware that diseases may remain asymptomatic for some time. You should be alert for this possibility for 6-12 mo after returning and inform health care personnel of your travel to a tropical environment. Any unexplained fever, jaundice, skin lesions, diarrhea, weight loss, or flu like symptoms should be investigated by personnel experienced in tropical medicine.

Further Sources of Information

Due to the proliferation of information we recommend that you cross verify with multiple quality information sources. The following sources were of good quality as of 2 April 2000.

 [Online]. Available: http://www.acithn.uq.edu.au Site of Australian Center for International & Tropical Health & Nutrition. Good information for travelers to and from Austral-Asia.

 [Online]. Available: http://www.amref.org Site of the African Medical Research and Education Foundation based in Nairobi. Good information regarding travel in Africa and other medical resources.

 [Online]. Available: http://www.cdc.gov/ travel Site of the Centers for Disease Control and Prevention. Excellent web site with specific information for different regions.

 [Online]. Available: http://www.cybermall.co.nz/NZ/IAMAT Site of the International Association for Medical Assistance to Travelers. Good advice for travelers to the Pacific and Asia.

 [Online]. Available: http://www.iata.org Site of International Air Transport Association. Regulations regarding transport of biologic samples on international air carriers.

 [Online]. Available: http://www.internationalsos.com Site of a leading company for international travelers health, medical evacuation insurance, and country information.

 [Online]. Available: http://www.istm.org/ Site of the International Society of Travel Medicine. Updated disease information

 [Online]. Available: http://www.katadyn.ch Site of a manufacture of high quality water filters

 [Online]. Available: http://www.sti.unibas.ch/travel-research.htm Site of Swiss Tropical Institute. Updated research on travel medicine

 [Online]. Available: https://www.tripprep.com/scripts/main/default.asp A listing of travel medicine providers around the world.

 [Online]. Available: http://www.who.int Site of the World Health Organization. Updated information on diseases and international travel throughout the world.

Have a good trip!