Letters to the Editor

(This is a reply to a letter from Kathrin Love, MD asking why ISTM does not have position papers on important topics in travel medicine.)

Dear Kathrin,

Certainly, position or consensus statements would be helpful for many among travel health professionals. However, as I painfully experienced during my term as ISTM President, this is difficult to achieve.

According to our Society by-laws, Article 4.1, it is our goal "to develop guidelines and recommended principles that will be disseminated to those working in the area". In the past, whenever we tried to agree even on `simple' topics, some members opposed that on the basis of having differing traditions in specific countries or differing products. It was claimed that unless a recommendation was unanimously supported by the membership, it could not be an ISTM recommendation.

However, times change, and it may be time to reassess such questions in the Executive Board and appropriate committees.

Robert Steffen, MD, Zurich
Head, Division of Communicable Diseases
Director, World Health Organization
Collaborating Centre for Travellers' Health
Institute of Social and Preventive Medicine (ISPM)
Zurich, Switzerland

Dear Editor:

Re: Israeli Response to Indian Earthquake

On January 26, 2001 at 08:45, an earthquake took place in the Kutch region in the State of Gujarat, India. The quake came in two waves, and lasted more then 2 minutes, with the force of 7.9 on the Richter scale. The destruction was devastating. Entire cities were destroyed, entire neighborhoods were wiped out as houses collapsed. In the areas in which houses did not completely collapse, they were not fit for living. Thus, entire cities became huge encampments made of tents and plastic sheets.

Forty-eight hours after the quake, on January 28, the Government of India approached the Government of Israel with a request for medical aid. Within 24 hours an Israel Defense Force (IDF) medical mission was organized. The mission consisted of a field hospital with some 100 persons, including doctors, nurses, paramedics, x-ray and laboratory technicians. Based on previous experience, the medical team included orthopedic surgeons, general surgeons, gynecologists, internal medicine specialists, and experts in infectious and tropical diseases. We thought that in the first days there would be mainly victims of trauma, and then there would be patients with the infectious diseases endemic to India, and in view of the destruction of the infrastructure, there would be a risk of an outbreak of epidemics.

The Indian Government located us at Bhuj, the central city in the Kutch district. In this city there had been a district hospital with 400 beds that collapsed completely on the patients and staff during the quake.

Within a few hours our field hospital was set up and started operating. And, indeed, the majority of cases were orthopedic. Among the many orthopedic patients there were also pregnant women who went into labor. The first delivery was of a premature baby girl weighing 950 grams. Since we came equipped with the proper medical equipment, this little baby's life was saved. Word of this birth spread through the local media, according to which the child was called Israela. During our stay there, we performed 55 operations, including 3 cesarean sections, and 13 babies were delivered.

Surprisingly, no epidemics broke out, and the incidence of infectious diseases was very low, with the exception of infected post-trauma wounds. There was one post trauma case of tetanus in an old woman that occurred one week after she had been wounded in the quake. Hopefully, this was the only case that occurred. We discovered that the day after the earthquake, the Indian Army conducted a tetanus vaccination campaign, and this, together with the high vaccination coverage in the State of Gujarat, prevented more such cases.

During this time we observed the manner in which the local population coped with the aftermath of the quake. From them, we learnt an important lesson in helping one's neighbor. The level at which people helped each other was indeed awe inspiring. Priests and lay persons from all over India, and Indians from all part of the world, enlisted to help. Some came to help out at our hospital, either as medical personnel, or as translators. In the city itself, groups were formed to bring enormous quantities of food, and public kitchens were opened to serve food to the people. Bottled water was distributed by the government and private organizations. The facts that people had bottled water, properly prepared food, and the quake occurred in the dry season (the rainy season is in the summer), helped prevent outbreaks of food- and water- borne diseases.

Despite the widespread destruction and despite the high casualty rate - some 30,000 dead and many more wounded, we did not see scenes of despair. Bodies that were dug out of the ruins were immediately burned. People just continued to carry on their daily existence. Although people became destitute, they did not seem devastated. We asked the head of a monastery about the religious significance of the earthquake, whether it was regarded as a karmic punishment. He said that in his view the universe undergoes processes of building and destruction. Now there was destruction, but they would continue to build. This answer taught us much about the Indian philosophy of life, and the strength it gives the people to cope with such a devastating experience. We felt we came to help, but left having learnt an important lesson from them.

Eli Schwartz
Jerusalem, Israel

As host of your TRAVELMED list I seldom post to TRAVELMED except on list technical issues. I am taking the comments by David Freedman about the fact that travel medicine seldom makes it on the radar screen of travel reporters as an excuse for offering a suggestion.

It is not uncommon for interested groups to set up occasional training workshops for reporters. For example, the Carter Centre in Atlanta runs training workshops for reporting on mental health issues - to train reporters. I have seen similar efforts for improving the training of science reporters.

ISTM might consider experimenting with a modest training curriculum for travel writers, to be held as a one-day workshop in conjunction with the ISTM meetings. The curriculum could grow into something that could be farmed out for regional workshops, or it could start as a regional initiative and be brought to the ISTM meetings once it matures.

Lastly, ISTM, or groups within ISTM, might consider doing a survey of
travel reporters/writers asking them if such a workshop would be useful
and what it should cover. I would be interested in collaborating with any efforts in this area.

Sam Lanfranco,
ISTM TRAVELMED ListHost/Administrator

I am very saddened that the New York Times and all it's world wide readers will lose the insight, honesty, humor and integrity that Betsy Wade has brought to the Practical Traveler column and travel journalism for 600 plus articles over 14 years.

As an avid reader of her column it never ceased to amaze me how she "gets it right" - summing up big issues into sage advice that can be used by travelers and travel professionals and keeping the travel industry (include travel medicine) on its toes. She is a true journalist - finding and focusing on facts and communicating them to the public in a clear, sensible way. She is not swayed or fooled by bias (and is quick to admit her own when it may exist on an issue) or influence.

And she has contributed to our dynamic and evolving field of travel health/medicine. Besides her many well written, fair and even handed articles on travel medicine topics over the years (from Lariam to travel med on the web), Betsy has been a supporter of ISTM and an active member (a member of the Public Education and Training Committee). She has attended many of the ISTM conferences and has always been in eager pursuit of the facts both in the lecture rooms and the hallways. Again, she comes to the conferences with a mission to understand the facts, the breaking news and subtleties and to share her knowledge and insight.

The ISTM and the field of travel medicine should be honored to have had the ear and interest of such a dedicated first-rate professional, and wonderful person, for so many years. I wish a friend and colleague the best of luck on her next adventures.

Rebecca W. Acosta, RN, MPH
Executive Director
Traveler's Medical Service
New York, NY