Travel Health - reducing the risk of things going wrong

February 2005

The following article is of significance for any organisation that expects its staff to travel overseas as part of their job. It is even more important if they are going to areas where disease is rife! It has been written by an ex medical colleague of mine, Dr. Charlie Easmon. Charlie has more letters after his name than I have had the proverbial hot dinners. I have added his bio at the end of his article along with his company's contact details.

Why is travel health important to you?
The UK has successfully rid itself of many diseases that still plague the poorer parts of the world. Damage to the liver (hepatitis) can cause tiredness and in some cases cancer. Tetanus can cause spasm of the jaw and death. Typhoid can cause a hole in the gut and death. Polio can cause paralysis. Rabies once it reaches the brains is 100% fatal. We all know someone who was severely ill or sometimes we knows of death from malaria. Decent travel health advice can significantly reduce these risks.

The legal reason
Employers owe a duty of care to employees. An engineering firm had to settle out of court with a widow who’s husband died of malaria. Her lawyers successfully argued that he should have received up to date malaria prevention advice. The unfortunate man was only told about the risk of yellow fever. A lawyer successfully won a six-figure sum from her own law firm after it failed to warn her of the risk of amoebic gut diseases in West Africa.

Properly documented, accurate travel health advice can reduce the risk of these six-figure payouts.

The financial reason
Court or out of court payments as noted above are an obvious cost saving but who audits the cost of illness. How many people have returned from abroad and been wrongly diagnosed by their GP. Some people are told they have irritable bowel syndrome, which is a life-time diagnosis for what may be a parasitic illness and could be treated in a week.

How many people with malaria end up on intensive care or too ill to work. Even hepatitis can put you out of action for several months. You and your work force deserve the best and most up to date advice available. Good travel health advice is not an area to falsely try and save costs. Many employers show no interest at all in where or whether their employees receive travel health advice.

If 20 engineers go to see 20 different general practitioners (GPs), it is almost a certainty that they will have 20 different opinions ranging from the well-informed to the truly appalling. You should want to be certain that all 20 have had the best advice possible and that this is consistent. With this knowledge you can feel re-assured` that the duty of care has been met.

The logistical reason
You are pulling a team together from different locations. You may even disperse them overseas. Why not make sure they all have the same written travel health brief? See if a provider can go to them, if you cannot bring them all to one place to see the provider. Why not make sure one provider keeps all the health records for you and ensures completeness? How many times has someone said “I don’t remember what I had and when I had it”? This is costing you money.

A simple example: if you have 2 hepatitis A vaccinations within one year of each other no more is required for 10 years. However, people forget the second jab and have to start again, each time at a cost of more than £40. Why not choose a provider who can ensure a recall is made as and when the next vaccinations are due?

You have sent your engineer to a malarious area. The mission was supposed to be 3 months but it has been extended. Who do you ask to provide more malaria tablets? The NHS GP is not allowed to prescribe for more than three months to someone going abroad. You need a provider who can source and deliver the medication to your engineer.

What should you think about for comprehensive travel health duty of care?

Firstly ask yourself do I even have a travel health policy?

If not think what should it contain or who can I ask to write me one?

A good travel health policy would consider the following:

• What are the risks to your travellers?
• Who advises your employees or contractors on travel health risk?
• What resources do the service providers use to give your employees or contractors the most up to date advice?
• Does each person have a record of what they have had and is it regularly up date?
• Do you give them written travel health information or an oral health brief or both?
• Have you checked their insurance?
• Have you checked that they know their blood group and that they are at most risk of road accidents?
• Can you reduce the risk of road accidents? (i.e. advise no self-driving in the first 24 hours after a long-haul flight?)
• Have you assessed for the risk of Deep Vein Thrombosis (DVT)?
• Have you assessed fitness of the individual to travel?
• Will you supply any sort of medical kit, including anti-diarrhoeal medicine?
• Have you talked about sexual health risks?
• What do you know about the quality of local medical facilities?
• What system do you have in place for assessing post-travel illness?
• How will you cope with next SARS like illness overseas?

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