- Email: [email protected]
Pre-deployment, travel health advice for humanitarian health workers: Helping the helpers
Travel Medicine and Infectious Disease (2014) 12, 543e544
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevierhealth.com/journals/tmid
CORRESPONDENCE
Pre-deployment, travel health advice for humanitarian health workers: Helping the helpers
KEYWORDS Relief work; Humanitarian help; Safety measures; Risks
Dear Madam, in the recent special issue on Occupational and Military Travel Medicine, Ku ¨pper et al. highlight the health hazards facing young volunteers working overseas [1]. This is an important paper as there are few studies or analyses addressing volunteer health risks. There are even fewer papers on recommendations for preparing humanitarian aid workers. Indeed, there is a veritable dearth of guidelines on pre-deployment travel health advice and safety preparations for volunteers on relief missions to help them protect their own health. In the last decades, there has been an increase in natural disasters and global catastrophes, and the willingness to help shown by compassionate people has resulted in a steady increase in humanitarian relief work and in the numbers of associated humanitarian helpers deployed. This situation led also to an increase in research on the topic, but the focus was mostly on the victims of the disasters so that a lack of research exists relative to the health of the humanitarian helpers. An important factor in relief work is a ready and quick response. However, because willingness does not correspond to readiness and training requires time, the rapid deployment of well-prepared and trained humanitarian health workers is difficult. Although volunteers are a valuable asset in the humanitarian sector, it must be stressed that well-meaning, motivated and compassionate but poorly trained volunteers may become a liability to both themselves and to those they are trying to help [2]. They can rapidly become a burden for the already challenged and damaged health care in the disaster region by not being prepared to protect themselves from preventable and minor illness. Paramount is to respect the foundation of assistance: primum non nocere, do not harm. http://dx.doi.org/10.1016/j.tmaid.2014.08.001 1477-8939/ª 2014 Elsevier Ltd. All rights reserved.
Many authors evaluating relief workers returning after Hurricane Katrina [3], the Haiti Earthquake [4], the 2004 South East Asian Tsunami disaster [5], or location unspecific [6], showed a similar report on illnesses suffered during the relief work but a mostly heterogeneous spectrum on the pre-deployment health and safety preparations and teaching received. Regardless of the global region of deployment, certain basics should be addressed in the pre-travel encounter with humanitarian volunteers. These include vaccinations both routine and destination specific, protection against mosquito and insect bites, anti-malaria strategies (if appropriate), food and water precautions, prevention and treatment of travellers’ diarrhoea. The proportion of workers receiving pre-deployment vaccination ranges from 50% [3] to 83% [5] (regardless of baseline immunization status). A medical check-up before deployment occurs in 42% [5] to 100% [6] of the workers. Insect bites are often reported [1,3] but the use of insect repellent, mosquito nets or malaria chemoprophylaxis is variable in the predeployment teaching/preparation and also adherence to the therapy/procedure during deployment [3,6] is variable. Travellers’ diarrhoea is the most frequent illness reported [1,6] but is difficult to prevent. A valuable approach has been described by Garner et al. [7], where volunteers consuming only army rations and imported water when taking part in an humanitarian relief mission during the South East Asian Tsunami disaster with the result that no diarrhoea was observed in any member of the team. Most organisations offer some kind of training and preparation in the form of courses, brochures or manuals but heterogeneous training models and the need for fast deployment mean that little time for training remains. Of course a distinction has to be made between established organizations, that provide state-of the-art preventive measures, e.g. the Swiss Agency for Development and Cooperation, the International Committee of the Red Cross or the World Health Organization, where potentially exposed individuals have all required immunizations and are prepared for immediate departure, and less professional organizations that leave medical pre-departure preparation in the hands of the deployed personnel. It would appear of great importance that every humanitarian health worker or volunteer should only go on a relief mission in collaboration with an organisation and that in
544 advance of deployment, a minimum of pre-travel advice and pre-deployment safety measures should be observed. There is a need to define guidelines regarding pre-travel advice for this vulnerable group.
Conflict of interest The authors declare that there are no conflict of interest.
References [1] Kupper T, Rieke B, Neppach K, Morrison A, Martin J. Health hazards and medical treatment of volunteers aged 18e30 years working in international social projects of NonGovernmental Organizations (NGO). Travel Med Infect Dis 2014;12:385e95. [2] Peytremann I, Baduraux M, O’Donovan S, Loutan L. Medical evacuations and fatalities of United Nations High Commissioner for Refugees field employees. J Travel Med 2001;8: 117e21. [3] Swygard H, Stafford RE. Effects on health of volunteers deployed during a disaster. Am Surg 2009;75:747e52. discussion 52e3.
Correspondence [4] Nelan M. Responding to haiti’s earthquake: international volunteers’ health behaviors and community relationships. Int J Mass Emerg Disasters 2013;31:293. [5] Aitken P, Leggat P, Robertson A, Harley H, Speare R, Leclercq M. Pre- and post-deployment health support provided to Australian disaster medical assistance team members: results of a national survey. Travel Med Infect Dis 2009;7: 305e11. [6] Bhatta P, Simkhada P, van Teijlingen E, Maybin S. A questionnaire study of voluntary service overseas (VSO) volunteers: health risk and problems encountered. J Travel Med 2009;16:332. [7] Garner AA, Harrison K. Early post-tsunami disaster medical assistance to Banda Aceh: a personal account. Emerg Med Aust 2006;18:93e6.
Marco Costa1 University of Zurich, Centre for Travel Medicine, Hirschengraben 84, Zu¨rich, Switzerland E-mail address: [email protected] 30 July 2014
1
SAMD Board Members: Martin Oberholzer-Riss, Christoph Hatz, Patricia Schlagenhauf, Robert Steffen. Former member: Margot Mu ¨tsch.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevierhealth.com/journals/tmid
CORRESPONDENCE
Pre-deployment, travel health advice for humanitarian health workers: Helping the helpers
KEYWORDS Relief work; Humanitarian help; Safety measures; Risks
Dear Madam, in the recent special issue on Occupational and Military Travel Medicine, Ku ¨pper et al. highlight the health hazards facing young volunteers working overseas [1]. This is an important paper as there are few studies or analyses addressing volunteer health risks. There are even fewer papers on recommendations for preparing humanitarian aid workers. Indeed, there is a veritable dearth of guidelines on pre-deployment travel health advice and safety preparations for volunteers on relief missions to help them protect their own health. In the last decades, there has been an increase in natural disasters and global catastrophes, and the willingness to help shown by compassionate people has resulted in a steady increase in humanitarian relief work and in the numbers of associated humanitarian helpers deployed. This situation led also to an increase in research on the topic, but the focus was mostly on the victims of the disasters so that a lack of research exists relative to the health of the humanitarian helpers. An important factor in relief work is a ready and quick response. However, because willingness does not correspond to readiness and training requires time, the rapid deployment of well-prepared and trained humanitarian health workers is difficult. Although volunteers are a valuable asset in the humanitarian sector, it must be stressed that well-meaning, motivated and compassionate but poorly trained volunteers may become a liability to both themselves and to those they are trying to help [2]. They can rapidly become a burden for the already challenged and damaged health care in the disaster region by not being prepared to protect themselves from preventable and minor illness. Paramount is to respect the foundation of assistance: primum non nocere, do not harm. http://dx.doi.org/10.1016/j.tmaid.2014.08.001 1477-8939/ª 2014 Elsevier Ltd. All rights reserved.
Many authors evaluating relief workers returning after Hurricane Katrina [3], the Haiti Earthquake [4], the 2004 South East Asian Tsunami disaster [5], or location unspecific [6], showed a similar report on illnesses suffered during the relief work but a mostly heterogeneous spectrum on the pre-deployment health and safety preparations and teaching received. Regardless of the global region of deployment, certain basics should be addressed in the pre-travel encounter with humanitarian volunteers. These include vaccinations both routine and destination specific, protection against mosquito and insect bites, anti-malaria strategies (if appropriate), food and water precautions, prevention and treatment of travellers’ diarrhoea. The proportion of workers receiving pre-deployment vaccination ranges from 50% [3] to 83% [5] (regardless of baseline immunization status). A medical check-up before deployment occurs in 42% [5] to 100% [6] of the workers. Insect bites are often reported [1,3] but the use of insect repellent, mosquito nets or malaria chemoprophylaxis is variable in the predeployment teaching/preparation and also adherence to the therapy/procedure during deployment [3,6] is variable. Travellers’ diarrhoea is the most frequent illness reported [1,6] but is difficult to prevent. A valuable approach has been described by Garner et al. [7], where volunteers consuming only army rations and imported water when taking part in an humanitarian relief mission during the South East Asian Tsunami disaster with the result that no diarrhoea was observed in any member of the team. Most organisations offer some kind of training and preparation in the form of courses, brochures or manuals but heterogeneous training models and the need for fast deployment mean that little time for training remains. Of course a distinction has to be made between established organizations, that provide state-of the-art preventive measures, e.g. the Swiss Agency for Development and Cooperation, the International Committee of the Red Cross or the World Health Organization, where potentially exposed individuals have all required immunizations and are prepared for immediate departure, and less professional organizations that leave medical pre-departure preparation in the hands of the deployed personnel. It would appear of great importance that every humanitarian health worker or volunteer should only go on a relief mission in collaboration with an organisation and that in
544 advance of deployment, a minimum of pre-travel advice and pre-deployment safety measures should be observed. There is a need to define guidelines regarding pre-travel advice for this vulnerable group.
Conflict of interest The authors declare that there are no conflict of interest.
References [1] Kupper T, Rieke B, Neppach K, Morrison A, Martin J. Health hazards and medical treatment of volunteers aged 18e30 years working in international social projects of NonGovernmental Organizations (NGO). Travel Med Infect Dis 2014;12:385e95. [2] Peytremann I, Baduraux M, O’Donovan S, Loutan L. Medical evacuations and fatalities of United Nations High Commissioner for Refugees field employees. J Travel Med 2001;8: 117e21. [3] Swygard H, Stafford RE. Effects on health of volunteers deployed during a disaster. Am Surg 2009;75:747e52. discussion 52e3.
Correspondence [4] Nelan M. Responding to haiti’s earthquake: international volunteers’ health behaviors and community relationships. Int J Mass Emerg Disasters 2013;31:293. [5] Aitken P, Leggat P, Robertson A, Harley H, Speare R, Leclercq M. Pre- and post-deployment health support provided to Australian disaster medical assistance team members: results of a national survey. Travel Med Infect Dis 2009;7: 305e11. [6] Bhatta P, Simkhada P, van Teijlingen E, Maybin S. A questionnaire study of voluntary service overseas (VSO) volunteers: health risk and problems encountered. J Travel Med 2009;16:332. [7] Garner AA, Harrison K. Early post-tsunami disaster medical assistance to Banda Aceh: a personal account. Emerg Med Aust 2006;18:93e6.
Marco Costa1 University of Zurich, Centre for Travel Medicine, Hirschengraben 84, Zu¨rich, Switzerland E-mail address: [email protected] 30 July 2014
1
SAMD Board Members: Martin Oberholzer-Riss, Christoph Hatz, Patricia Schlagenhauf, Robert Steffen. Former member: Margot Mu ¨tsch.