Portal de Periódicos da CAPES

Travel Medicine and the Travel Industry

2006; Elsevier BV; Volume: 17; Issue: 1 Linguagem: Inglês

10.1580/1080-6032(2006)17[71

1545-1534

Gary Podolsky,

Global Public Health Policies and Epidemiology

To the Editor: It is beneficial for travel agencies to work together with travel medicine clinics in order to promote client health and happiness. Recent publications have commented on the relationship between travel medicine practitioners and the travel industry.1.Schiff A.L. The travel industry and medical professionals.in: Steffen Dupont Textbook of Travel Medicine and Health. BC Decker Inc, Hamilton, Ontario, Canada2001: 11-15Google Scholar A recent travel medicine study reported respondents having a negative relationship with travel agents.2.Neumann K. ISTM and the travel industry: a saga. ISTM Newshare. May/June 2004. Available at https://www.istm.org/WebForms/Members/IndexSecure.aspx. Accessed Oct 31, 2005.Google Scholar Our travel clinic has had very positive interactions with our local travel agencies, and we wish to share these experiences. Travel agents work either through small, private, family-sized businesses or through large-scale corporations. Agents may own their businesses and be highly self-motivated or work in a franchise that provides little motivation for innovation. Agents may be community college diploma graduates or may also receive additional training. Some agencies provide specialized travel options such as corporate, conference, cruise ship, and adventure travel packages. Others specialize through personal heritage or interest in Asian, Australian, European, African, or South American travel. Almost every conceivable niche has been explored. Travel agents are a heterogeneous group with different experiences and motivations. The travel industry exists to make a profit, and workers are not trained to make medical assessments, though many will go out of their way to assist clients. Some use private databases to review medical requirements necessary for travel. Others refer their clients to a travel medicine clinic or public health department when required. Well-traveled agents are more likely to refer patients to clinics, especially if their clients require certification of immunization for yellow fever or meningitis. Conversely, a minority of travel agents perceive that referral to a travel medicine clinic will dissuade their clients from travel and result in a loss of business. In light of the history of travel medical advice, this attitude is not wholly unreasonable. Pregnant women were once advised to forgo travel to chloroquine-resistant areas, whereas today's medical recommendations now support this travel. Recommendations have frequently changed in the past, and older travel agents may be influenced by previous negative experiences. Agents and patients now have access to the same information that was previously available only to those with subscriptions to fax updates or medical journals, and they will notice inconsistencies very quickly. For example, Carlson Wagonlit–Thomas Cook obtains medical advice through a subscription service and uses this to advise patrons when to see a physician. Travel medicine clinics started out of public health groups and then evolved to become immunization clinics reacting to specific diseases such as cholera, smallpox, yellow fever, and typhoid. Present-day clinics offer specialized consultations including new and extensive immunizations. This shift has gone from reaction against a possible lethal contagion (with a high degree of certainty as to the necessity of doing so) to present-day proactive measures in preventing illnesses, many of which may not be life threatening (eg, travelers’ diarrhea and nonfalcipiform malarias). There is now greater uncertainty regarding what is required or recommended, and more choices are available. Some countries’ guidelines differ from those published by the Centers for Disease Control and Prevention and the World Health Organization. A diligent individual will be able to research treatments that may be different from those locally recommended. Travel medicine practices may vary in interpretation, which also leads to confusion among laypeople as to what constitutes a travel medicine specialist. Full-service clinics may provide pre- and posttravel services as well as specialized vaccines such as yellow fever, typhoid, and rabies, which may be unavailable from family practitioners. Other clinics may be part of a larger general practice with the additional resources of covering obstetrics, pediatrics, and immunocompromised patients (eg, those with human immunodeficiency virus infections). Alternative-medicine practitioners also claim expertise in this field and use homeopathic remedies for such diseases as malaria and schistosomiasis. In our area, one suntanning salon merged with a mainstream travel clinic to promote health benefits of pretrip tanning. Travel medicine practitioners must be able to show a true value in their services for which they expect patients to pay. To establish value in their services, clinicians must address issues involving different vaccine manufacturers, types of vaccines (eg, oral vs injectable typhoid), anti-immunization groups, and occasional supply failures (eg, recent shortages of yellow fever, meningitis, and rabies vaccines). Clinicians should also be willing to talk about limitations such as adverse reactions (eg, egg allergies and yellow fever vaccine) and nonresponders. The usefulness and cost of vaccines should be discussed with clients. Travel medicine clinics must be able to provide guidance and advice to the travel industry regarding these issues. Immunization practices have risen and fallen and will continue to change. Whether they consist of a mild ache from the needle itself, anaphylaxis from egg allergies, or more severe possible problems from vaccines like yellow fever, adverse effects should be thoroughly discussed for all immunizations. By explaining to others how we arrive at our practice guidelines with the best current information available, we authenticate our clinics, even if practice guidelines change in the future. Travel agencies and travel medicine clinics have many similarities. Both wish to establish safe travel for their clients. Both have an incomplete understanding of what the other is doing. A continuing education dialogue will be beneficial in sharing basic health ideas. Our clinic uses the same lecture format used to instruct medical students and family practitioners and also gives regular lunchtime talks to local travel agents. Many travel agents are happy to refer their clients to travel medicine clinics, for this relieves them of any medical responsibility so that they can focus on their own business. When our clinic hired a former travel agent to be a general receptionist, our communications with the travel industry improved. We have found the following strategies to be helpful in reaching travel agencies in our area. Simply mailing out pamphlets and business cards explaining what services we offer lets the agencies know that we are here and interested in helping them. This explains how we will work with them to help last-minute travelers and see posttravel-sick patients urgently. We regularly cover the travel industry tradeshows. We also distribute to travel agencies written information (self-generated, pharmaceutical and government published) that addresses common travel problems. We have actively sought out groups such as Amnesty International and World Vision to host events for them. We suggest working equally with all local reputable travel agencies to avoid any preferential treatment. Finally, we recommend having a website. A low-cost solution is the ‘online business card,’ which is a static, nonchanging pamphlet. For more money, your website may link with more-established sites, and you may add your own online content (eg, essays, current events). This will enable agencies and other clients to be able to easily find you and have access to a large amount of information. Stay away from travel-related businesses that sell or advocate health products that are not evidence based and may indeed be harmful. This lowers a clinic's credibility. All efforts made to improve and increase communications between travel agencies and travel medicine clinics will be of reciprocal benefit to both parties and will ultimately benefit our mutual clients. The onus remains on the medical community to convince agencies of our usefulness. This can be accomplished with a well-planned marketing strategy (which does not have to be expensive) that uses the lingo and symbols of the travel industry and not those of the medical community.