International Touring with a Large Orchestra

Peter De Beer

The world famous André Rieu and his Johan Strauss orchestra, based in Maastricht, Netherlands, have been touring Europe for more than two decades and, in 2000, added concerts in the Americas and the Asia-Pacific region. Each year the number of concerts and the size of the orchestra has increased.

Andre Rieu's shows are far more than an orchestra playing music. The shows include dancing, singing, acting, elaborate stage sets and sophisticated lighting. And Andre's enthusiasm shows no sign of wavering; there were 120 performances in 2007. In December, the performances grew to spectacular proportions. In Toronto, there were nightly audiences of 30,000. And as the show grows in size and in the frequency of performances, the number of performers and supporting staff also grows. For large shows, there may be 500 individuals involved - 250 performers and 250 assisting crew - not to mention 90 containers packed with meticulously designed sets and other paraphernalia.

Over the years the medical assistance part of the tour has also grown in importance, and is now an integral element of the tour. In the early days, the orchestra toured Europe without medical assistance, until a widespread outbreak of gastro-enteritis amongst the musicians and crew brought the tour to a halt. Because of this and because of the then decision to tour the Americas and Asia, Andre decided to provide medical counseling for the orchestra in Europe, and on-the-spot medical assistance for the orchestra overseas.

Now medical planning is under the supervision of a physician and such planning is an integral part of all tours. This has helped tours to go more smoothly and has helped reduce the risk of illnesses among tour members, illnesses that might interfere with performances or even require cancellations.

Tour members consult routinely with the tour doctor about their current illnesses even when not on tour. This makes members more comfortable with travel and enables the doctor to try to resolve problems before the tour commences. It also allows the doctor to recommend which medications tour members should add to their personal, compact first-aid kits, in addition to medications needed for specific destinations.

The presence of a doctor traveling with the orchestra helps minimize the tour members' health and well being worries and provides peace of mind for the families left at home. The doctor's presence has also helped reduce health insurance costs since fewer members seek medical care while traveling. Large hospital and outpatient bills for treatments in countries such as the USA and Canada have been greatly reduced and have helped to lower the annual insurance fees for the production management.

Assembling a medical kit

Experience has also shown that due to baggage restrictions, logistics of transporting a medical kit and expiration dates of medications, traveling with an extensive pharmacy is unfeasible. Therefore, much planning is required in assembling a concert tour medical kit.

Planning begins with studying the tour route, concert venue sites, and leisure time destinations and checking if there are any health issues that need addressing because of the itinerary. A tour which goes directly from sunny Los Angeles to wintry Winnipeg results in large temperature changes, bringing with it an increase in common colds and more serious conditions, such as upper and lower respiratory tract problems. Such factors must be considered when deciding on the contents of the tour medical kit.

It is very helpful when crossing borders with a large supply of all kinds of medications to have a comprehensive list of all items in the kit. Also helpful is for the doctor to have at hand copies of his diplomas and medical status in his home country, international medical certificates and licenses, and translations of these documents in the language of the country being visited.

Another important aspect of planning a tour is having access to competent physicians at every destination. This can be arranged through friends and colleagues from the International Society of Travel Medicine network or via other professional networks, airlines, and international companies for example. Such contacts are vital when problems arise that cannot be handled with the medical kit or when a tour member requires admission to a hospital. The response from these contacts has been very gratifying.

The tour doctor's primary function is to give first aid assistance, to treat minor medical issues, and to help tour members with their psychosocial problems. Such problems can negatively influence their performance. This "holding of hands" support is invaluable to orchestra and crew. They wake up in a different city almost every day. It is a comfort to them to be able to seek advice in their native language with the tour doctor who they consider an integral part of the group.

The tour medical kit

In previous years, trying to predict the possibility of which illness would occur and trying to be prepared for all eventualities resulted in a cumbersome medical kit being carried all over the world. The kit was similar to those used at sporting events or on a ship and not designed for portability. The average weight of the kit was 15 kg. Over the years the contents and use of items in the kit have been reevaluated, culminating in the present tour medical kit (TMK). Furthermore, TMK has been divided into three parts: an emergency kit, TMK-A; a basic kit, TMK-B; and a stock pharmacy kit, TMK-C.

TMK-A weighs 2 kg (including stethoscope, earscope and sphygmanometer). TMK-B weighs 6 kg. The TMK-C weighs more than 10 kg and is used to stock the other two kits. The compact nature of TMK-A and TMK-B mean they can be easily carried by the physician and kept close to hand. The TMK-C is transported by the equipment truck.

TMK A and B are carried by the physician and used in three contingencies, each with its own requirements. The first is during travel by bus, train or airplane. Traveling to a concert venue takes anywhere from one to twelve hours, and it is wise to have medications available, just in case. Having medications on hand enables prompt treatment if necessary without the need for aid from local doctors or pharmacists. This saves time and thus speeds the healing process. In addition to being available in transit, this on-the-spot service is also available to tour members at the hotel at which the orchestra is staying.

The second contingency is at the concert venue during the time between arrival and the start of the concert performance. The routine of a concert day involves rehearsals, dinner, wardrobe and make-up before the performance itself. The presence of the medical kits ensures that, in case of illness, crew or orchestra members can consult with and, if necessary, be treated by the doctor without the necessity of leaving the venue.

The third contingency is at the concert venue during the concert performance. If medical help is required during the performance it is always urgent. Time is critical, both for the success of the show and the well being of the patient. The doctor's quick reaction and presence are urgently needed in these situations. The physician carries the TMK-A during concert performances. TMK-B and TMK-C are kept back stage and, when necessary can be quickly summoned by a crewmember.

Conclusion: these finely tailored TMK kits are easily transported and efficient to use. They prevent not only worsening of illnesses in travelers far from home but they contribute to the physician's performance by providing reliable equipment at hand without the physician feeling like a `walking ambulance'. The compact size of the kits also minimizes physical stress on the physician of carrying an oversized medical kit.

Peter A.M. de Beer is the Chief Medical officer of the Orchestra Andre Rieu, Specialist adviser in Travel and Tropical Medicine, Director, Medical Services for the Tropics-Maastricht

Email mstropics@planet; correspondence P.O.Box 1660; ZIP 6201 BR Maastricht; The Netherlands

Emergency Set (A)

General Set (B)

Peter is a long time member of the ISTM. He was born in the Netherlands in 1951. He had post-graduate training in general practice and then received a diploma in tropical medicine and hygiene from the Tropical Institute Leopold II in Antwerp. After graduation, he did humanitarian work for Doctors without Borders in Somalia and Sudan. In 1988, in Sudan, he discovered an epidemic of visceral leishmanisis. Several years later he started his own travel and tropical medicine clinic in Maastricht, Netherlands. He is also an organizer and co-director of the annual travel and tropical medicine course at the IPK Tropical Institute in Havana, Cuba, and is the supervising physician of a chain (KeurCompany) of travel clinics that has 30 locations throughout the Netherlands.