A safe blood supply is something many in the U.S. take for granted.  All countries don’t employ the same precautions to ensure their blood bank is safe or have an adequate supply available – for example in some areas in Europe, patients are required to find donors to replace the blood they use.

June 14, 2011 marks the annual recognition of World Blood Donors Day. As described by the World Health Organization (WHO) this worldwide event is meant to “raise awareness of the need for safe blood and blood products and to thank voluntary unpaid blood donors for their live-saving gifts of blood.”

In the U.S. every two seconds someone needs blood. If you’re looking to help provide a solution to this problem, visit the American Red Cross website to find a blood drive.

If you’re abroad and want to join in on the festivities, view the list of world events here.

Thanks to all who give!

New research published this week in the prestigious medical journal The Lancet has disclosed the presence of super bacterium NDM-1 in the drinking and ground water in Delhi, India. NDM-1 resists treatment by the most powerful antibiotics available and could spark a worldwide spread of untreatable infections. NDM-1 has already been carried from India to Europe by “medical tourists” who contracted the infection during a hospital stay.

Upon learning this news, the World Health Organization (WHO) sounded an alarm asking medical researchers around the globe to take up an urgent collective effort to combat NDM-1. The WHO is particularly concerned because

• The population density of India suggests that millions of people may already be carriers
• The NDM-1 gene has spread to bacteria that cause dysentery and cholera, which are easily passed among humans who drink sewage-contaminated water
• 650 million people in India do not have access to toilets served by sewers

WHO Regional Director Zsuzsanna Jakab said “Given the growth of travel and trade in Europe and across the world, people should be aware that until all countries tackle this, no country alone can be safe.”

Photo by SAsqrd.

In sharp contrast to conventional wisdom, there are a number of places outside the U.S. where the cost of medical care can be higher than for the same care at home.  In my role as Medical Director for HTH Worldwide, I see proposed treatment plans and cost estimates that would cause patients without travel health insurance serious financial pain. For example,

• Surgeon’s fee to remove a thyroid gland in China at $9,000.  The same procedure would cost approximately $1,000 in the U.S., with insurance discounts.
• Laparoscopic pelvic surgery in South America in the amount of $13,000. Cost is around $7,000 in the U.S. with insurance discounts.
• Psychotherapy in England may cost as much as $200 per hour.  The average therapist in the U.S. would be happy with half that amount.

In addition, many foreign practitioners generate supplemental income by selling prescription medications directly to patients, and think nothing of recommending more expensive alternatives over older, proven therapies.  Examples include new antibiotics and tumor necrosis factor blocker medications such as Humira and Enbrel.

Unless travelers protect themselves by purchasing travel health insurance, they will be faced with paying the quoted rate or footing the bill for evacuation to the U.S. for tens of thousands of dollars. Most major U.S. insurers provide spotty coverage for healthcare services obtained while visiting foreign lands—and sometimes none at all.  Travel health insurance provides not only coverage, but also a watchful eye to insure that patients receive only effective, evidence-based treatment.

HTB’s readers are one of the most globally connected groups we know. These connections produce knowledge of the disparity in health, education and life expectancy that prevail around the world, and with that knowledge comes responsibility. While we aren’t trying to guilt you into trading your comfortable job for subsistence farming, we’d like to suggest making at least a modest gift to any number of very worthy organizations around the world that channel charitable giving directly and effectively to those who need it most. You can start by checking out Nick Kristof’s recent column in the NY Times. Mr. Kristof is making a career of identifying innovative yet simple models for helping each other. He highlights organizations delivering hope in the form of medical care, literacy, education and dignity for women and children in Afghanistan, Haiti, Congo, Somalia and Cambodia. Take the time to learn more. We’re sure you will be moved to give.

Photo by Darren Tunnicliff.

With epidemics and outbreaks threatening many developing countries, there is a need for more epidemiologists and public health workers to collect data and respond to the situation.  International law now requires countries to report certain outbreaks or public-health events and to improve their disease surveillance and response capabilities, but a shortage of trained epidemiologists limits their ability to comply.  The Centers for Disease Control and Prevention (CDC) are helping to fund 35 programs mainly in developing countries to train health workers in epidemiology to better prepare them to identify epidemics.  Eleven more programs are in the works. According to the Wall Street Journal, the initiative is modeled after the CDC’s Epidemic Intelligence Service program, which helped to detect HIV/AIDS, eradicate smallpox, and discover a deadly strain of E. coli. 

By battling outbreaks such as the current cholera epidemic in Nigeria, the expansion of these programs can save many lives. Trained officers can track down cases, help treat patients and educate others.  CDC director Thomas Frieden said in an interview that if epidemiologists had been able to detect H1N1 in Mexico two months earlier, a vaccine would have been ready before the biggest peak hit the U.S. last year, and could have saved thousands of lives.  He believes that to be able to sufficiently measure disease threats, there needs to be at least one epidemiologist per 200,000 people. Using this rule of thumb, worldwide demand for epidemiologists would be 34,500 based on the 6.9 billion humans that inhabit the planet today. By some estimates there are no more than 5,000 worldwide today. Over the past 30 years, for example, only 2,200 people have graduated from CDC epidemiology programs. 

Despite this shortage of expertise, epidemiologists soldier on. Some of the outbreaks or public health problems currently being tracked by CDC-funded programs include:

• Nigeria: Cholera epidemic that has led to more than 1,000 deaths
• Ethiopia: Acute-diarrhea that sickened 10,000 in Addis Ababa
• Kyrgyzstan: HIV among children in Bishkek
• Ghana: Rabies
• Egypt: H5N1 and H1N1 flu
• Pakistan: Viral hepatitis
• Thailand: Pneumonia in mushroom-farm workers caused by fungi
• China: Melamine-contaminated infant formula

Source: Centers for Disease Control and Prevention

The CDC is expanding its training programs to include Vietnam, China, Kazakhstan, Uzbekistan, Ethiopia, Iraq and Afghanistan.  The CDC is also working on creating shorter courses to train local officials in basic data collection.  The competent collection of timely data leads to improved disease surveillance and response strategies from which the whole world benefits. 

Photo by Eneas.

The recent discovery of a rare amoebic infection in two organ transplant recipients catapulted an unusual, but catastrophic, risk of organ transplantation into international headlines. The Centers for Disease Control reported that four people in three states received organs from a patient suffering from neurological problems who died at the University of Mississippi Medical Center in November.  Two of the organ recipients are now critically ill.      

Transplant patients are particularly susceptible to developing severe symptoms of infectious diseases, as they must be given drugs that weaken the immune system in order to prevent organ rejection.  Although organ donors are routinely tested for common pathogens such as the hepatitis and human immunodeficiency viruses, unusual infectious agents may escape the screening process.  According to Dr. Kenneth Kokko, the medical director of kidney transplants at the University of Mississippi Medical Center, “We test for the known harmful diseases, but there’s not a test for every single pathogen out there.”

Though the occurrence of Balamuthia mandrillaris amoeba is extremely rare, even more common entities, such as bacterial infections, tuberculosis, rabies, and cancer may evade detection prior to the harvesting of organs. Many organ donors are young, healthy victims of severe trauma who have had little or no medical screening.  Such patients may be asymptomatic carriers of chronic infections or have undiagnosed tumors. For example, an Oregon donor in his 40s with a history of alcohol abuse who tested negative for hepatitis C, was later found to have the virus.  Ninety one different tissues and organs were given to forty patients over a 22 month period.  Eight patients were infected, and two later died.  In this case, the donor escaped detection because of the eight to ten week window between infection and the development of detectable blood markers for the disease.

All these cases have been reported in the country with the reputation for the highest standards in medical care. Of course, the potential transmission of life threatening illness is potentially even greater for those wishing to travel overseas for an organ transplant.  Although there are very few U.S. residents who do this today, the number is likely to grow as the availability of organ donors fails to keep pace with the demand.  Indeed, over 9,000 people per year in the U.S. die waiting for organ transplants.  Given the choice between succumbing and finding a donor overseas, most people would be willing to take the risk of an exotic, undetected illness to receive a life saving transplant. Even in the United States, transplant centers seem to be more accepting of deceased donors with high risk behaviors, such as intravenous drug use.  The short interval required to match sick patients with donors also increases the risk of missing a transmissible disease that is not routinely tested for.

In conclusion, “caveat emptor” or “let the buyer beware”  As the widow of one unfortunate recipient commented  “The kidney transplant was supposed to be the gift of life, but the infection that came with it ended up taking it away.”

I guess I drew the short straw.  Here it is the last day of the year, and I have been tasked with writing the pivotal year-end post.  Except that this year, it is the pivotal decade-ending post.  I realize that today is not the last day of the first decade of the third millennium.  As many others have pointed out, there was no year 0, so technically the year 2000 was the end of the second millennium, and we won’t complete the first decade of the third until the last day of 2010.  I will, however, go with the flow and cave in to the lower standard that seems to prevail in the mainstream media.

This decade was marked by many changes.  The Wall Street Journal’s article by Alan Murray titled “A 10-Year Dose of Reality” offered up a view focused on the economy and business with bubbles, scandals and global upheaval, but also highlighted that this decade saw the largest reduction in poverty ever, the emergence and growth of world-changing new technologies and the election of our first black president.  He also threw in Susan Boyle for good measure.

Given that the Healthy Travel Blog has somewhat of a focus (I have been accused of trying to derail this sometimes), I will address the advances we have seen in medicine in this decade.  I could also choose terrorism, travel security (somewhat in the news today), pandemics, climate change and natural disasters, but didn’t.

I am not going to reinvent the wheel when ABC News, in collaboration with MedPage Today, has already conducted a large survey and process to figure out the top 10 medical advances of the decade.  Their authoritative list is:

1. Human Genome Mapping
2. Doctors and Patients Harness Information Technology
3. Anti-Smoking Laws and Campaigns Reduce Public Smoking
4. Heart Disease Deaths Drop by 40 Percent
5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances
6. Targeted Therapies for Cancer Expand With New Drugs
7. Combination Drug Therapy Extends HIV Survival
8. Minimally Invasive Techniques Revolutionize Surgery
9. Study Finds Heart, Cancer Risk With Hormone Replacement Therapy
10. Scientists Peer Into Mind With Functional MRI

Items 1, 2, 5, 6 and 10 seem mostly focused on the future.  3, 4, 7 and 8 are in full force now, and 9 is really a finding that past practices had big unknown risks.  Number 7 stands out for me through a personal connection.  My brother-in-law, an internist in Philadelphia, has told me how great the change has been in the United States for patients with HIV/AIDS.  Instead of a ward filled with dying patients, he now treats patients with a chronic condition well-managed by a pharmaceutical cocktail.  Outside of the U.S. the biggest advances have been in the reduction of transmission rates.  New advances are being worked on with vaccines and gene therapy.

What do you think was the biggest advance in the last decade?  How about the biggest challenge for the future?  Let us know by leaving a comment, and we will follow up in more detail.

Here’s hoping that the next decade brings peace to the world and progress for all.  Happy New Year!

Photo: http://www.flickr.com/photos/wohinauswandern/4231050474 / CC BY 2.0

Despite the rapid rise in medical tourism over the past five years, the vast majority of Americans remain reluctant to travel outside of the United States for medical care even if it means saving thousands of dollars.  Perhaps the main reason is concern about the quality of medical care, and the lack of universal credentialing and certification of foreign facilities and physician providers. (Read what Travel & Leisure has to say about the benefits vs. risk of medical tourism.) That may soon change, however, as at least two nonprofit organizations have begun tackling the formidable task of qualifying those who market medical care to an international audience.

The better known of the two organizations is the Joint Commission International.  The JCI has accredited 300 public and private health care organizations in 39 countries since 1999. These organizations include hospitals, ambulatory care centers, clinical laboratories, primary care services and disease or specific condition care centers using international best practice standards. It does not, however, investigate the practices of individual physicians or allied health professionals, or provide ratings based on consumer feedback. 

The more recent entry into the medical tourism space is the Medical Tourism Association, also known as the Global Healthcare Association. According to their website, the MTA is the “first international non-profit association made up of top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment.”  Although this organization is designed to promote the interests of its members, it does collect and disseminate consumer driven data to insurance companies and prospective patients.  In an attempt to remain credible, they attest to transparency in quality, pricing, and patient safety.  They claim that their information is “unbiased with regard to patient outcomes.”

Anyone contemplating travelling abroad for medical care should contact these organizations for information, and, while we aren’t in a position to endorse their credentialing methods, we would advise prospective medical tourists to give some weight to their findings. We would also note that there are many places in the world that have yet to come under their scrutiny.

Part of our focus on healthy travel is to build an appreciation for the doctors and hospitals around the world that make special efforts to treat sick and injured travelers.  Well, it turns out that many of these healthcare providers also go out of their way to care for some of the neediest people on the planet. We opened a window on this activity when we introduced some of the doctors and hospitals that work most closely with us to an organization called Global Giving , a philanthropic network dedicated to supporting grass roots programs worldwide.

Through Global Giving, our community of doctors and hospitals applies HTH-funded donations to the philanthropic projects of their choice.  The funds support a diverse range of healthcare projects worldwide – equipment for a hospital in Haiti, mosquito nets for families in East Africa and immunizations for children in the Philippines, just to name a few. 

Over the years, I have learned that despite their busy practices, many of the doctors and hospitals we work with have initiated and nurtured a wide variety of philanthropic projects.  Many provide care free of charge to uninsured local patients who can’t afford it-the CIWEC Clinic in Kathmandu provides free rabies treatment, Dr. Marcos Pacheco e Silva provides dental care free of charge to patients with Down’s Syndrome, HIV and Hepatitis C at the University of São Paulo, and the Dubai Bone and Joint Center founded The Emirates Arthritis Foundation  which raises funds for arthritis patients in need.  In partnership with the Cardiac Children Foundation of Thailand (CCF), Bumrungrad Hospital has given life-saving heart surgery free of charge to 276 children since 2004. 

Others, like Dr. Paul Zakowich, our Regional Physician Advisor in Singapore, help lead medical relief missions to Cambodia and Laos, while the CURE International  hospital in the Dominican Republic regularly receives orthopedic surgeons from the United States to perform life-changing operations on young local patients.  Physicians at the Central Health Medical Practice in Hong Kong  provide medical care to orphans in China.  One of my favorite projects is headed by Dr. Tim Meade in Lusaka, whose organization “Tiny Tim and Friends“ provides medical care and support to HIV-positive orphans and other vulnerable children in Zambia.  Sometimes, projects are on a larger scale:  the renowned University College of London Hospitals  has developed a long-term program to exchange staff and expertise with a sister institution in Kampala, Uganda.

It’s our plan to use this space to describe these initiatives in more detail.  We hope that by promoting wider appreciation of these efforts, we will encourage greater participation and investment in improving the lives of the neediest around the world.