David R. Shlim MD, Newly Elected Board Member
David R. Shlim, MD is well known to the ISTM community from his lectures at the biennial CISTM conferences and his valuable contributions to the ISTM listserv. He was elected to
the Executive Board of the ISTM at the May 2007 meeting in Vancouver. Like his friend, Eric Caumes, who was also just elected to
the Executive Board, David has attended every ISTM meeting since Zurich in 1988.
David grew up in Portland, Oregon, where he learned to climb mountains. At age 13 he climbed the highest mountain in Oregon. David's interest in mountaineering and high altitude illness led him to Nepal in 1979, where he served as a volunteer doctor at the Himalayan Rescue Association aid post in Pheriche, near Mt. Everest. Living and working in a remote valley at 14,000 feet (4270 meters) gave him a unique perspective on the medical problems of adventurous travelers, particularly high altitude illness. After three seasons at Pheriche (totaling nine months in the mountains), David moved to Kathmandu to work at the newly created CIWEC Clinic in 1983. He became the Medical Director the following year and ran the clinic until 1998. He hired Prativa Pandey, MD in 1993 and turned the clinic over to her in 1998. Prativa is the recent past-president of the ISTM. David remains closely involved with the clinic.
The CIWEC Clinic was the first destination travel medicine clinic in the world, and is still the busiest. The clinic provided an opportunity to study the diseases of travelers in a destination country, and the research that the clinic generated helped define the diagnosis and treatment of many diseases as they present in travelers. David has authored over 35 original papers on travel-related illnesses including traveler's diarrhea, typhoid fever, hepatitis, altitude illness, rabies prophylaxis, and the causes of death among trekkers. The clinic helped discover Cyclospora, and provided the first clinical description of this disease, the first epidemiologic studies, and the definitive treatment study.
The CIWEC clinic has had a major impact on the ISTM. It is the busiest GeoSentinel site, contributing the most patients to the database every year. The current executive board has four people who have worked at the CIWEC Clinic: David Shlim, Prativa Pandey, Nancy Jenks, and Eli Schwartz.
In addition to caring for travelers and expatriates in Nepal, David also provided free medical care for the Tibetan monastic community and newly arrived Tibetan refugees. His close relationship with the head of one of the Tibetan monasteries, Chokyi Nyima Rinpoche, led to collaboration on a book called Medicine and Compassion: A Tibetan Lama's Guidance for Caregivers (Wisdom Publications, 2004). The book explores the nature of compassion, and how a medical practitioner can learn to make one's compassion more stable and more encompassing in order to be able to deal with difficult patients and situations more easily. He is the author of a chapter on compassion in the highly recommended new book, Immigrant Medicine.
David moved to Jackson Hole, Wyoming in 1998 with his wife, Jane, and two children, Matthew (now 17 years old), and Anna Tara (now 12 years old). Since that time, David has practiced travel medicine, worked for companies that provide travel medicine information, lectured around the world, and pursued his interest in medicine and compassion. He travels regularly to lecture on medicine and compassion, including talks at the Harvard School of Public Health, Yale University, University of California at San Diego, and University of Florida. He also teaches two Tibetan Buddhism classes in Jackson. He is currently writing a memoir of his experiences in Nepal.
Jackson Hole has a world famous ski resort, and David's whole family enjoys skiing throughout the winter, both at the ski resort and in the backcountry. David is an avid road cyclist in the summer. A unique hazard on the roads near his home is the herds of bison (American buffalo). Individual bison, which can weigh as much as 2200 pounds (1000 kilos), can charge a cyclist, making it nerve-wracking to ride past a herd grazing near the road.
David's path to medicine was not as smooth as some. After dreaming of being a doctor since age five, he dropped out of his first year of medical school at Rush Medical College in Chicago. He returned a year later and managed to finish, but only did one year of internship before heading off to family practice and later emergency medicine prior to moving to Nepal. He had no background in medical research, and credits his early collaborators, David N. Taylor, MD and Charles H. Hoge, MD for teaching him how to produce good papers. David developed a reputation along the way for being an original thinker in travel medicine, often questioning conventional wisdom and producing fresh insights on difficult problems. His lecture at the CISTM meeting in New York in 2003 questioning whether personal hygiene precautions can prevent traveler's diarrhea has led to an overhaul of our thinking on that topic. Over the years, David has received awards for his research from both the ISTM and the Wilderness Medical Society. Last fall, David became the first American to be made a fellow of the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons in Glasgow.
One of his proudest achievements was creating a high quality travel medicine conference called Medicine for Adventure Travel in Jackson Hole, Wyoming. The course grew out of a collaboration with Bradley Connor and David Taylor. The conference has been held seven times since 1993. The motto of the course is "the science behind travel medicine," and the topics always address the cutting edge concerns of travel medicine. The course was last held in 2006, and the timing of the next course has not been set.
As a member of the ISTM Executive Board, David's interests are to try to put travel medicine in perspective, to try to document the actual risks of travel, and to understand the value of specific travel medicine recommendations. When there is no scientific way to decide what to recommend, travel medicine has to rely on common sense, or at least an understanding of why there is no easy answer. An example of this problem is what to recommend to travelers in areas with a minimal risk of malaria.
His biggest dream in travel medicine is to sing his song, "Eve of Infection," at the opening of the Budapest CISTM.
Here is an excerpt from David's chapter on compassion in Immigrant Medicine:
"All of us have compassion in relative degrees at different times. However, our ability to maintain the desire to ease suffering is often limited. It is easiest for us to care about our own families and close friends and relatives. We may also find it easier to care about people with whom we share some common heritage or beliefs. Beyond that, it becomes more difficult to demonstrate strong compassion towards those we don't know. And most of us find it almost impossible to be kind and compassionate towards those who are making it difficult for us, or have harmed us in the past. How many of us were able to feel compassion towards the September 11, 2001 hijackers along with their victims?
In addition, we may feel that we just don't have enough energy to care about what happens to people in all corners of the world. The range of suffering experienced in other parts of the world often goes so far beyond our imagination that it appears to be happening on another planet. There are very few Americans who have ever spent even a passing moment trying to imagine what it would be like to be forced from their homes by a marauding militia, fleeing on foot for days or weeks, and winding up across the Mexican border with a handful of possessions, no money, not speaking the local language, and wondering what was going to happen to them that night, much less the rest of their lives.
Those in the medical profession who take care of immigrants often do so by choice, probably because they have some sense of the suffering that many have been through, and want to try to help. An immigrant population may be more needy than other patient populations. They may have language obstacles, and a lack of cultural understanding. They may have logistical, emotional, or psychological problems that make it difficult to care for them. After some time, our ability to maintain compassion may start to erode.
That situation speaks to the heart of the problem. How does one increase or stabilize compassion when you already feel that you are trying as hard as you can? Is compassion fixed like a character trait, or can it be modified through training? If our compassion can decrease - something we all unfortunately seem to experience at times - can it be increased?"
Abstract from "Looking for Evidence that Personal Hygiene Precautions Prevent Traveler's Diarrhea." [CID 2005;41 (Suppl 8): S531-535]
"In the 50 years of study of traveler's diarrhea (TD), it has always been assumed that personal hygiene precautions can prevent or reduce the likelihood of TD. However, 7 of 8 studies that specifically addressed this issue showed no correlation between the types of food selected, and the risk of TD. The 8th study showed a correlation between a few dietary mistakes and a decreased risk of TD. A further increase in the number of mistakes, however, did not continue to increase the risk of TD. Personal hygiene precautions, when under the direct supervision of an expatriate operating his or her own kitchen can prevent TD, but restaurant hygiene in most developing countries continues to create an insurmountable risk of TD in travelers."
