Have vaccination, will travel (medicine)

Simon Morgan is a GP, medical educator and (newly frustrated) travel writer from Newcastle, Australia. He is on Twitter: @drsimonmorgan

I like travelling. When I say that, I don’t mean driving to the supermarket or catching the bus into town; rather, packing a bag and setting off to explore a new destination. To travel is to dare — it challenges our assumptions, our values and occasionally our GI tracts. It is contradictorily both uplifting as well as grounding. Gustave Flaubert, the 19th century French novelist, is quoted as saying “Travel makes one modest, you see what a tiny place you occupy in the world”. Travel broadens the mind and deepens the understanding (and lengthens the credit card bill).

And after a few decades of frequent travel, I have come to think that jetting off is not all selfish hedonism — it also benefits our patients. Mark Twain asserted that “Travel is fatal to prejudice, bigotry, and narrow-mindedness”, qualities that certainly don’t belong in any decent general practice encounter. Travel can thus make us better doctors.

And perhaps due to my wanderlust, I also like travel medicine. There’s something vicariously rewarding in teasing out a patient’s itinerary, be it backpacking through Vietnam or cruising the Danube, and giving sage advice on everything from rabies to rupees. Especially as the travel health encounter is usually a tropical island of wellness in an otherwise stormy sea of chronic disease and ill-health. Travel medicine is fun. It’s a constantly evolving field, embracing acute care, public health and risk communication. With the majority of travel medicine encounters conducted in primary care, at least here in Australia, it is appropriately regarded a core aspect of general practice.

But not so long ago, travel medicine wasn’t even a thing. Well, obviously it existed — people travelled and got sick, including Alexander the Great who died from malaria on a package tour to Persia in 323BC — but not by that name. For years it was called emporiatrics, a term which was both confusing and definitionally incorrect. Deriving from the Greek emporos, meaning merchant or trader, strictly speaking emporiatrics means business travel. However, with ‘hodoiporiatric medicine’ apparently the etymologically more accurate but even more impenetrable name, calling it travel medicine was a no-brainer.

In fact, the Journal of Travel Medicine only embarked in 1994. Its first editorial, on page 1 of issue 1 of volume 1, tellingly titled “Travel medicine – what’s that?”, enthusiastically described this “new interdisciplinary field” and its central tenet of “keeping the traveler alive and healthy”.¹ Alongside a call for expanding the knowledge base through appropriate research, it also flagged the mainstay of provision of information to travelers on the three Fs — food/beverages, flies/mosquitoes and flirtation/unprotected sex. (Personally, I would label the overly polite third F as a missed opportunity for a fledging journal to announce its arrival with a splash).

The first edition of JTM featured an eclectic mix of articles, including papers on the ill health of Scottish missionaries² (11% died, with Calabar in Nigeria being particularly lethal), long-term follow-up of CBT for fear of flying (it works)³ and a brief communication on malaria in Tasmania (unsurprisingly, it’s not very common).⁴ There was even a letter to the editor, which I reckon was pretty impressive for a journal that had hitherto never been published.

But since the arrival of COVID-19, my travel, and travel medicine practice, have been derailed. Australia’s borders have effectively been closed since March and international tourism is suspended. Even domestic travel is drastically curtailed. Where there’s no travel, there’s no travel medicine. Well, technically. In an effort to maintain my emporiatric skills, I have taken to routinely incorporating a few travel tips into my other consultations. Call it over-inclusive, but I can’t see the harm in giving advice on the dangers of kava intoxication⁵ or how to extract a guinea worm with a stick⁶ to a patient presenting for a repeat prescription for their statin. You can’t be too careful.

French novelist Marcel Proust once wrote that “the real voyage of discovery consists not in seeking new landscapes, but in having new eyes”, a reflection as relevant to our discipline of general practice as it is to travel. One day soon we will again travel. And I will be able to discuss the risk of breaking a leg bungee jumping⁷ without raising an eyebrow.

 

References

1. Steffen R, et al. Travel Medicine: What’s that? J Travel Med 1994;1:1-3.
2. Cossar J, Dow D. Effects of Ill Health on the Service of Scottish Presbyterian Missionaries 1867–1929. J Travel Med 1994;1:16-29.
3. Foreman E, Borrill J. Long-Term Follow-Up of Cognitive Behavioral Treatment for Three Cases of Fear of Flying. J Travel Med 1994;1:30-5.
4. Goldsmid J, Sullivan P. Malaria in Tasmania 1987-1992. J Travel Med 1994;1:55-6.
5. Spillane P, Fisher D, Currie B. Neurological manifestations of kava intoxication. Med J Aust 1997;167:172-3.
6. Mbong EL et al. Not every worm wrapped around a stick is a guinea worm: a case of Onchocerca volvulus mimicking Dracunculus medinensis. Parasit Vectors 2015;8:374.
7. Burchett D, et al. Femoral Shaft Fracture during Bungee Jump: A Case Report and Literature Review. Bull Emerg Trauma 2018;6:262-6.

 

Featured photo by Ellen Jenni on Unsplash