As a desperate power struggle unfolds in Libya, its neighbors fear hundreds of thousands may flee across the Mediterranean to seek asylum in Italy, Cyprus, France, Greece, Malta and Spain. Italian Foreign Minister Franco Frattini said the region should brace for a “biblical exodus” because one-third of Libya’s population—2.5 million people—are recent immigrants from sub-Saharan Africa who are now caught in a society reduced to bitter tribal rivalries. Dangerously exposed, they may choose to flee north rather than return to their home countries. Many Mediterranean ports of call may see a heavy influx of refugees in the near term, straining social services and perhaps requiring the United Nations to help create camps and processing centers.
Archive for February, 2011
Travel Bulletin Southern Europe: Wave of Libyan Refugees May Wash Ashore
Thursday, February 24th, 2011 by Mike HartungThe Medical Hazards of Demonstrating
Thursday, February 24th, 2011 by Frank Gillingham, MD
In news reports released earlier this week, Libyan authorities confirmed that at least 61 people had died in the capital city of Tripoli during demonstrations against the long entrenched government of Moammar Gadhafi. In addition, over 100 people have been reported killed in the eastern cities of Benghazi, and Beyida There are even reports that soldiers and police have been executed for refusing to kill fellow Libyans.
Demonstrations in recent weeks have also led to deaths in Egypt, Bahrain, Yemen, and a host of other countries in the Mideast. Details may be reviewed on the CNN website. Mortality figures make the headlines, but there are untold numbers of others who have suffered significant injuries and illnesses as a result of participating in anti-government gatherings and rioting. Military personnel, police, and other pro-government forces have used a variety of different techniques for crowd control, including firearms, tear gas, water cannons, and batons. In addition to penetrating wounds from firearms, a number of other serious injuries such as blunt head trauma, severe breathing problems, ruptured abdominal organs, open fractures, and spinal injuries have resulted from the use of excessive force against demonstrators.
Anyone traveling to the Mideast should check to see whether or not the State Department has issued a travel warning for their destination. Travel Warnings are issued when dangerous conditions compel the State Department to recommend that Americans either avoid or carefully consider the risk of travel to that country, or when they believe that the U.S. Consulate or Embassy may not be able to assist American citizens who encounter difficulty. The countries affected are listed on the Department’s website.
Finally, it is incumbent upon any traveler to the Mideast to avoid all demonstrations and large gatherings of protesters, and to follow the advice of local authorities. Visitors are advised to exercise caution and restraint, and to avoid unnecessary travel in the later hours of the day and at night. It is also important to check with their travel insurer. Some policies exclude coverage in countries where travel advisories have been issued, or for injuries and illnesses sustained as a result of participation in a demonstration or riot.
Photo by Peta-de-Aztlan.
Web-based Symptom Checkers: Travelers’ Aide or Not?
Friday, February 18th, 2011 by Frank Gillingham, MD
Travelers to remote locations with limited or no options for professional medical care often have access to the Internet and thus the ability to seek out web-based tools to diagnose conditions and recommend medical triage. Even those in the comfort of their own homes have made free self-help symptom checkers a popular pastime on the web.
How useful are they? In vetting some of the most popular of these “checkers”, it appears that they produce a lot of information but fall short of providing definitive answers. For instance, WrongDiagnosis.com, provides a list of 1,729 causes for abdominal pain and vomiting and 1,300 causes for cough and throat symptoms.
Other symptom checkers, such as OptumHealth.com provide only a modicum of information for most problems, and appear quick to pull the trigger for a doctor referral. When entering the symptoms of headache and virtually any other symptom such as fever, a history of high blood pressure or band tightness around the forehead, the user is always told to call the ambulance or physician’s office.
WebMD’s symptom checker appears slightly more useful, but often falls short of providing detailed information. It usually limits the patient to just a few rounds of questions, and then offers a number of possibilities. Although the list is nowhere near as exhaustive as WrongDiagnosis.com, WebMD stops short of a doing a deeper dive for symptoms of abdominal pain and vomiting and lists 20 possible diagnoses.
The Mayo Clinic’s symptom checker was similar. It provided a comprehensive checklist of symptoms for the user to select. However, despite requesting a more detailed history than the WebMD site, the number of possibilities declined slightly, if at all. When additional history was added to the complaint of upper abdominal pain with vomiting, such as the quality of the pain, timing, exacerbating factors, and associated symptoms such as diarrhea and fever, there were still over 20 options for a diagnosis.
The symptom checker from Everyday Health, designed to mimic the real experience of providing a medical history to a health care professional, does perhaps the best job of identifying medical maladies. The website uses an extensive number of algorithms — responses to each question prompt another series of questions — ultimately providing the end user with a much smaller number of possibilities. The process takes much longer than the other symptom checkers, and often results in a recommendation to see a health care professional anyway, but still deserves kudos for its efforts to be more specific.
In fairness to all online symptom checkers, the identification of illnesses is often challenging because disease symptoms overlap. For instance, abdominal pain with vomiting can be associated with dozens of causes, and it may not be realistic to expect a symptom checker to accurately identify even a limited number of illnesses. It’s reasonable to expect web-based checkers to improve on their results, so feel free to use them, but keep your expectations in line.
Other popular symptom checkers worth checking out:
Photo by southerntabitha.
Travel Bulletin: More Capitals Shaken by Demonstrations
Monday, February 14th, 2011 by Mike HartungSuccessful citizen revolts in Tunisia and Egypt have set off a wave of demonstrations in capital cities in the Middle East and North Africa with dissidents seeking to throw off decades of political repression. International news organizations are reporting marches and skirmishes with police that may be the beginning of sustained efforts to force major changes in regimes. From Algiers, Cairo, Tehran, Tunis, Tripoli, Damascus and Khartoum to Bahrain, Iraq, Jordan, Yemen and the Palestinian Territories, autocrats are promising reforms even as their streets are sometimes the scene of brutal confrontations. Travelers should continuously consult news reports and be ready to modify their itineraries accordingly.
Sharing the Road Safely in a Strange Land: Resources for World Travelers
Friday, February 11th, 2011 by Mike Hartung
We recently highlighted the five-year initiative to reduce traffic fatalities in ten countries. It’s led by a consortium of impressive organizations (see below). But if you’re taking to the roads of a foreign country, there are resources available to improve the odds against becoming a statistic. The Association for Safe International Road Travel (ASIRT) publishes detailed, extensive and very helpful Road Travel Reports for 150 countries. If you look over the sample they provide for Peru, you’ll find nine pages covering topics such as these:
- Driver Behaviors
- Road Conditions
- Pedestrian Concerns
- Night Travel
- Seasonal Travel
- Police Enforcement/Road Regulations
- Dangerous Roads
- Buses/Taxis
- Crime/Off-limits areas
- Tourist Assistance
It’s an impressive and extremely practical compilation. If “Know Before You Go” is your motto, these reports are for you. To help fulfill its not-for-profit mission, ASIRT asks for donations to entitle you to download the reports. There are four different levels of participation starting at $30. A $150 donation enables you to download up to ten countries.
Joining ASIRT, Johns Hopkins and the World Health Organization in the consortium operating in the ten targeted countries are the World Bank, Global Road Safety Partnership and the EMBARQ arm of the World Resources Institute. We will continue to dig into the good work they are doing around the world and report our findings.
Photo by ChezShawna
Seeking Online Help for Mental Illness Sufferers
Wednesday, February 9th, 2011 by Frank Gillingham, MD
“Adjustment disorder” is defined by psychiatrists as a reaction that causes emotional or behavioral symptoms in response to a change in someone’s environment. The causes are multiple — a relocation, divorce, or job change — and universally result in feelings of anxiety, panic, a sense of being overwhelmed, and/or depression.
Travelers, particularly those who have experienced severe emotional stress in the past (history of abuse, military conflict, loss of a loved one, etc.) are at increased risk of suffering from adjustment disorder. Unfortunately for business travelers and students, the symptoms may impede work or academic performance, providing additional stress.
One of the more widely used treatments for adjustment disorder is cognitive behavioral therapy: the practice of training one’s mind to redirect negative thoughts. A normal treatment course with a professional therapist varies from 6 to 12 sessions, during which time patients are given exercises to restructure negative thinking patterns in order to interpret their environment in a less biased way. For example, patients who experience persistent panic attacks are encouraged to test out beliefs they have related to such attacks, such as specific fears tied to bodily sensations, and to develop realistic responses to such beliefs.
It may not be practical for a traveler who is attempting to deal with the symptoms of adjustment disorder to seek help from a trained cognitive behavioral therapist. They simply do not exist in many parts of the world, or may be prohibitively expensive. One interesting alternative has been developed by the Australian government, which has created an “e-hub” suite of online self-help services on Facebook Those looking for help can use a free service called Beacon to get in-depth assessment of many online self-help web sites (free and fee-based). Using Beacon, I found a site called Stress and Mood Management that is based in part on cognitive behavioral therapy. Reviewers gave this fee-based service a positive rating. Unfortunately, it is currently undergoing an update and is unavailable.
But there are plenty more web sites to be explored. We will continue searching for self help resources — both in the management of medical conditions and mental illness — for all of our nomadic readers.
Photo by Eddi van W.
Egypt Is Back Online
Thursday, February 3rd, 2011 by Andy Orr
As a follow up to our report on the 28th, it seems that Egypt restored Internet service yesterday. In the aftermath of this event, it is even more obvious how important it is to have important information at your fingertips and with others. When trying to manage an evacuation, it really helps if your passport number, country and expiration date, birth date, full name, gender, cell phone number, email address, current location and desired destination are stored with your travel agent, school’s program director, immediate family member contact, etc.
Don’t count on the Internet and other communication services to be up and running from the epicenter of whatever situation you find yourself in. Be prepared.
Photo by Mike Licht, NotionsCapital.com.



