News from the Society

Some words from our President

Numbers of international travellers are growing from year to year. Globalisation goes forward. Our world is dramatically changing. Travel Medicine must accordingly advance.

The Travel Medicine (TM) concept was born a decade ago in Europe and North America. Its initial objective was to protect the health of travellers against travel associated risks. Which travellers? Mostly those going from more developed countries to countries with higher risk (tropical and/or developing countries). The targeted risks were mainly infectious. The main measures introduced were the prevention of risks through vaccination, chemoprophylaxis, and advice on safe behaviour.

In the course of 10 years of evolution, the field of TM has expanded to include non-infectious risks (such as trauma and cardio vascular problems - either one or the other being the leading cause for repatriation of travellers in most statistics), to the higher risk traveller (the elderly, pregnant women, young children, individuals with pre-existing health problems), to the risks associated with travel in climatic extremes, and to special problems linked to the mode of transport (air, sea, road) or activities (scuba diving, high altitude trekking).

Now the target population of TM is enlarged to all groups of travellers, including those coming from poor countries, migrants and displaced persons, pilgrims and those attending large gatherings.

TM is progressively developing in the most affluent countries, which send and receive the majority of international travellers, both as tourists (>600 million arrivals in 1997) and as business travellers. But TM is still under developed, perhaps even totally absent in many countries, notably in Eastern Europe, South America, South Asia and Africa. The duty of ISTM is to stimulate the implementation of TM in these countries, and to co-ordinate the national or regional facilities and organisations once they are started.

The further development of travel leads to the emergence of a new concern. What is the true impact of tourism, which is the motive behind the huge influx of affluent travellers to poorer, developing countries, attracted by sun, sea etc, on the development of these host countries? Can tourism improve the way of life, health conditions, or environment of the indigenous populations living around the 4/5 star hotels, holiday camps and other tourist facilities? Is it possible to achieve a balance between the potential predatory or beneficial consequences of tourism in these host countries?

In countries where it has been established, TM is organised and applied in different ways, according to varying national health systems. The specialised services are more public in some countries, more private in others. The involvement of GPs is appropriate and recommended in some countries, but can be fraught with difficulties in others. Regardless, for pre-travel and post-travel consultations, the practice of TM requires both a wide multidisciplinary competence and access to permanently updated information, preferably electronic. Similarly, appropriate training and re-training are essential for physicians, nurses and pharmacists involved in TM.

Moreover, public awareness (including direct mobilization through the media) on the importance of a pre-travel consultation before embarking on “higher risk” travel needs to be stimulated, all the more so as the travel industry seems difficult to motivate with this message.

International travellers can also be affected by emerging and re-emerging diseases, which now have the added enhancement of surveillance by WHO. Diagnosis of such diseases in ill travellers returning to their medically well-equipped countries may bring to light the presence of an emerging or re-emerging diseases, even an outbreak, inapparent until then in the visited, under-developed country (as shown by some recent cases of imported Yellow Fever and Japanese Encephalitis). So TM should and could contribute to the international surveillance of emerging and re-emerging diseases. This is an objective of the Geosentinel network.

These issues are of current concern to the Board and many members of ISTM. They could act as the catalyst for new trends and activities of our Society. A brain storming meeting about this concern was planned for last October at the time of the ASTMH Congress due to be held in Porto Rico. Unfortunately TM, travellers and ISTM must all take heed of the risk from natural disasters. Due to the devastating hurricane George all these meetings had to be cancelled. The ISTM brain storming meeting is now re-scheduled for June 1999 in Quebec, Canada, at the time of our next International Conference on TM. All ISTM members are kindly requested to express and send in ideas and suggestions to our Secretariat, Stone Mountain, GA, USA. E-mail: BCBISTM@aol.com

Michel Rey