The oral repellent – Whatever happened to it?

[Extract] Arthropod-borne diseases are endemic in many regions of the world with insect habitat expanding due to global temperature changes. Enormous amounts of money have been invested for decades in research and development of vector control and personal protection measures, yet, despite small successes, millions around the world still suffer or die from vector-borne diseases, such as malaria, dengue fever, leishmaniasis, Zika, chikungunya and many more. Consequently, travellers, scientists, missionaries, expats, and military personnel leaving for such destinations are at risk of infection and often diagnosed on return. The reason for infection rests on the shortcomings of the two main control measures: 1) vector control, and 2) personal protection. Table 1 presents a small sample of such shortcomings from a long list presented elsewhere

Designing an sssessment tool for tourism's health impacts in developing countries. Step 1: listening to local voices – an example from Peru

Objectives: It is widely acknowledged that tourism has an impact on visited people and places, especially in developing countries. Furthermore, there is a shift from the sole focus on economic benefits of an entrepreneur to the consideration of the needs of local people who have to live with the consequences of tourism at their doorsteps. The lack of a health assessment tool for current and prospective tourism developments that can be used by any stakeholder, but most importantly, by affected communities, and that is comprehensive, location-specific and easy to interpret, has been pointed out before. To date, no such tool exists. To ensure that locals' concerns, values and interests are considered, community-validated indicators must be developed. The objective of this study was to demonstrate how the content for locally meaningful indicators can be obtained based on people's perceptions of a healthy community. Methods: Thirty-five residents from two villages close to the Cordillera Huayhuash trekking circuit in Northern Peru took part in both interviews and ranking procedures, aimed at understanding the factors most important for a healthy community and, therefore, in need of protection or conservation in relation to tourism enterprises. Results: Out of 10 items, both villages ranked a combination of 'health', 'education', 'work' and 'family' as the most important aspects of a healthy community. The findings of the interviews emphasised different concepts, including 'environment' and 'harmony'. Each village had its own set of concerns linked to its specific ethnographic make-up. Conclusions: The method of obtaining local concerns was successful not only in yielding actual factors of interest but also in identifying village-specific differences. The results are useful for designing local-specific indicators to be added to indicators of generic health impact assessments. This meets the requirement of giving local people control over tourist developments and their prospective implications. The next step in the tool design will be to formulate appropriate questions per indicator and a range of degree of acceptability which can be used to assess and predict impacts on a community's well-being

Book review of "Healthy Travel: Central and South America" by Isabelle Young, Lonely Planet Publications, Melbourne, Australia

[Extract] This compact soft cover book (14x9x2cm; 200g, 456 pages) consists of 23 chapters, appendices, some WHO maps, many useful addresses/websites/contacts, and a number of drawings to illustrate the text. It is part of a series with three other volumes dealing with Africa, Asia & India, and Australia, NZ & the Pacific (these titles are not covered in this current review). The book fits easily in the tightest luggage. Due to the small size, the font size consequently is at a just acceptable level. A pretty green colour is used to highlight and decorate. Particularly important paragraphs are typed in this colour as well. Unfortunately, poor lighting such as from as a small bedside table lamp makes it very difficult to read these paragraphs, a lone 40 Watt bulb dangling from the ceiling of an Andean budget accommodation will wipe out this part completely, a shame considering that these are usually paragraphs of particular importance. The boxed texts have this colour as a background which may make then equally difficult to read (a >light-test= with the other titles revealed a similar problem, particularly the sandy beige of the volume on Africa)

Designing an assessment tool for Tourism's health impacts in developing countries. Step 2: asking the right question – an example from Peru

Background: Although there are many examples of tourism's positive economic, environmental and socio-cultural impacts, the severity of some of its negative implications has attracted the attention of academia and the industry for a long time. The focus on tourism's impact on destination health is more recent and, so far, there is no tool that allows the prediction and monitoring of such impacts. Impact assessment tools in other disciplines have been lacking the crucial inclusion of community-validated indicators. A tourism health impact assessment tool (TOHIAT) must focus on locals' concerns, values and views as it is they who bear the cost of a tourism development at their doorstep. Furthermore, the communities themselves should be able to use it rather than developers with vested interests. Method: This poster presents Step 2 of the design process with Step 1 having been presented at the CISTM11 in 2009. Thirty-five residents from two villages close to the Cordillera Huayhuash trekking circuit in Northern Peru discussed their views on the most important aspects of a healthy community. These aspects are at the same time those that need particular protection from the ramifications of tourism projects. Results: The six most discussed topics were: work, harmony, environment, individual health, education, and family. These concepts will form the basis of the TOHIAT with indicators, corresponding questions, and a visual summary tool allowing quick reference to current assessments results and to changes over time. Conclusion: The collected local concerns were successfully transformed into a manageable number of concepts that form the basis for the TOHIAT. This allows the inclusion of specific indicators as they are of interest to local people rather than outsiders with their respective agendas. The next step will be to focus on the details per indicator, the user-friendliness of the tool, translation into Spanish and testing in the field

More harm than good? The questionable ethics of medical volunteering and international student placements

It has been argued that much of international medical volunteering is done for the wrong reasons, in that local people serve as a means to meet volunteers' needs, or for the right reasons but ignorance and ill-preparedness harm the intended beneficiaries, often without volunteers' grasp of the damage caused. The literature on ethical concerns in medical volunteering has grown tremendously over the last years highlighting the need for appropriate guidelines. These same concerns, however, and an appreciation of the reasons why current aid paradigms are flawed, can serve as indicators on how to change existing practices to ensure a better outcome for those who are in need of help. Such paradigm change envisages medical assistance in the spirit of solidarity, social justice, equality, and collegial collaboration

Travel medicine, coca and cocaine: demystifying and rehabilitating Erythroxylum – a comprehensive review

Few travel health measures are as controversial as the use of coca leaves at high altitude; yet, there appears widespread ignorance among health professionals and the general public about coca, its origins as well as its interesting and often flamboyant history. Equally, the cultural and traditional significance to Andean people is not recognised. The coca leaves contain many alkaloids, one of which, cocaine, has gained notoriety as a narcotic, leading to the mistaken idea that coca equals cocaine. This article contrasts coca with cocaine in an attempt to explain the differences but also the reasons for this widespread misconception. By its very nature, there may never be scientific ‘proof’ that coca leaves do or do not work for travellers at altitude, but at least a solid knowledge of coca, and how it differs from cocaine, provides a platform for informed opinions and appropriate critical views on the current confusing and contradictory legal situation

Healthy, safe and responsible: the modern female traveller

One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues. Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks. Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs

Tourists' Knowledge of Leishmaniasis

[Extract] Cutaneous leishmaniasis is a parasitic disease transmitted by infected sand flies. An ulcerous skin lesion develops at the bite site which, after a number of weeks, is usually self-healing leaving a scar the size of the ulcer. Many overseas tourism destination are located in leishmaniasis endemic areas and numerous tourists have returned home with a scar reminding them of their infection. One parasite species, Leishmania braziliensis, can progress to a mucocutanous stage of the disease where infected individuals develop mucosal lesions in nose and mouth. Without treatment, these lesions can lead to disfiguring tissue destruction. L. braziliensis is endemic in Central and South American rainforests, coinciding with the geographical location of many national parks and hence tourism destinations. While leishmaniasis is a disease of the local population, tourists can be infected, even if they have been in the region for only a very short time. The only prevention from infection is not to be bitten. Therefore, travellers to endemic areas need to be advised of the existence of the disease and the preventive measures. However, the lack of inclusion of such information in travel health advice has been deplored in the literature

Where is travel medicine failing? Insights from high altitude trekking

[Extract] Before setting off on a holiday, particularly of the adventurous kind, it is vital to obtain appropriate medical advice to ensure a safe trip. However there are concerns that this need is not being adequately met. In this comment, Irmgard Bauer from James Cook University, Australia, discusses where travel medicine is failing and what can be done about it, in the context of her recent observations of travellers engaged in high altitude trekking