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Vso Medical Briefing 2008


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Vso Medical Briefing 2008

  1. 1. Don’t fall in the sewer & other matters of medical importance Mark Wise M.D., D.T.M. & H. (London) Don’t fall in the sewer … and other health advice
  2. 2. How can you tell an HIV positive person from one who is not?
  3. 3. How can you tell a rabid dog from a healthy one?
  4. 4. How can you tell if your salad is clean or infected?
  5. 5. Some VSO Policies … <ul><li>my role as Canadian medical advisor </li></ul><ul><li>the overseas medical advisor </li></ul><ul><li>your role as the volunteer </li></ul><ul><li>your blue and white medical form </li></ul><ul><li>what if you get sick </li></ul><ul><li>what if you get pregnant </li></ul><ul><li>confidentiality </li></ul>
  6. 6. VSO and Your Meds <ul><li>what medications are covered? </li></ul><ul><li>ceiling on medication costs - $5000.00 per year </li></ul><ul><li>make use of a drug plan if you have one </li></ul><ul><li>how many? </li></ul><ul><ul><li>antimalarials – 6 months </li></ul></ul><ul><ul><li>other meds – 1 year </li></ul></ul><ul><li>how to get renewals of your medications when in country? </li></ul><ul><ul><li>locate in country </li></ul></ul><ul><ul><li>e-mail Dr. Mark for renewal if necessary </li></ul></ul><ul><ul><li>meds will be couriered to field office </li></ul></ul><ul><ul><li>notify me of their arrival, or lack thereof </li></ul></ul>
  7. 7. <ul><li>We do </li></ul><ul><li>Recommended vaccinations for placement </li></ul><ul><li>Antimalarials </li></ul><ul><li>Prescription medications as listed on your medical form </li></ul><ul><li>Pre-placement medical exam </li></ul><ul><li>Recommended tests – Pap smear, TB test, blood type, etc. (if you are unsure as to what is really needed, please contact me in advance) </li></ul><ul><li>Tests required of placement country </li></ul>VSO Volunteers & medical expenses: What we pay for and what we don’t!
  8. 8. <ul><li>We don’t </li></ul><ul><li>Imodium and Cipro for diarrhea </li></ul><ul><li>Non-prescription medications </li></ul><ul><li>Vitamins </li></ul><ul><li>Unnecessary medical tests - feel free to contact me to clarify this in advance </li></ul>
  9. 9. <ul><li>Learn about the medical issues you might encounter, especially malaria and diarrhea. </li></ul><ul><li>Find out where you will get your medical care before you need it. </li></ul><ul><li>Be proactive about your health – both mental and physical. </li></ul>
  10. 10.
  11. 14. What to do if you get sick? <ul><li>make yourself better </li></ul><ul><li>let nature run its course </li></ul><ul><li>go to the local doctor/clinic </li></ul><ul><li>go to a bigger city with a better clinic </li></ul><ul><li>call for help! </li></ul><ul><ul><li>call VSO </li></ul></ul><ul><ul><li>call Dr. Mark </li></ul></ul>
  12. 15. Some women’s issues <ul><li>birth control </li></ul><ul><li>STDs </li></ul><ul><li>pregnancy </li></ul><ul><li>your period </li></ul><ul><li>feminine hygiene products </li></ul>
  13. 18. Most of what you need to know about HIV…. HIV is transmitted through blood, blood products and sex, so: <ul><li>abstain, or, USE A CONDOM ALL OF THE TIME </li></ul><ul><li>find out where you will get your medical care before you need it </li></ul><ul><li>know your blood type </li></ul><ul><li>avoid transfusion-prone situations – i.e. night buses </li></ul><ul><li>know about PEP (post-exposure prophylaxis) </li></ul>
  14. 32. What a day! I got robbed on the beach, hit by a bus, got drunk and had unprotected sex. I’m feeling a bit depressed … and tired. I can’t stand those Namibians anymore. I miss home.
  15. 33. Could I be depressed? <ul><li>I don’t wanna get out of bed in the morning. </li></ul><ul><li>I’m tired all of the time. </li></ul><ul><li>I can’t concentrate. </li></ul><ul><li>I wake up at 4 in the morning. </li></ul><ul><li>I’ve lost my appetite. </li></ul><ul><li>All I wanna do is eat. </li></ul><ul><li>I’m crying over little things. </li></ul><ul><li>I feel hopeless. </li></ul><ul><li>……… </li></ul>
  16. 34. How can you maintain your mental health? <ul><li>get lots of rest </li></ul><ul><li>try to get a healthy diet </li></ul><ul><li>get lots of exercise </li></ul><ul><li>keep a journal </li></ul><ul><li>learn the local customs and get involved </li></ul><ul><li>take time to yourself </li></ul><ul><li>spoil yourself from time to time – comfort bag </li></ul><ul><li>practice yoga, medication, etc. </li></ul><ul><li>keep in touch with people back home </li></ul>
  17. 40. Pre-travel inoculations REQUIRED RECOMMENDED ROUTINE TdP MMR TB skin test Yellow Fever Hepatitis A Typhoid fever Hepatitis B Meningococcus (ACYW-135) Rabies Cholera - Dukoral BCG
  18. 42. Boil it, bottle it, peel it, cook it or forget it … wash your hands … be selective!
  19. 43. Travellers’ Diarrhea: Clinical Presentation <ul><li>Bacterial diarrhea – short I.Pd.;abrupt onset of uncomfortable diarrhea, +/- fever, nausea, vomiting, blood or pus in stools </li></ul><ul><li>such as E. coli, salmonella, shigella, campylobacter </li></ul><ul><li>Parasitic diarrhea – longer I.Pd.;more gradual onset, gas, bloating, rumbling, nausea – takes longer to get to the doctor </li></ul><ul><li>such as giardiasis, amebiasis </li></ul>
  20. 50. Traveller’s Diarrhea: Self Treatment <ul><li>Fluid replacement - Gastrolyte , ORS </li></ul><ul><li>Antiperistaltics - Imodium </li></ul><ul><li>Antibiotics - Cipro (500mg bid x 3 d) </li></ul><ul><ul><ul><li>- Zithromax (500 mg/d x 3 d) </li></ul></ul></ul><ul><li>Antiparasitics – tinidazole, metronidazole </li></ul>
  21. 55. Pre-travel inoculations REQUIRED RECOMMENDED ROUTINE TdP MMR TB skin test Yellow Fever Hepatitis A Typhoid fever Hepatitis B Meningococcus (ACYW-135) Rabies Cholera – Dukoral JEV
  22. 61. Don’t play with dogs, or other furry animals!!! If you get bitten ….. <ul><li>wash the wound with soap and water </li></ul><ul><li>go to a big city with a good hospital </li></ul><ul><li>get the proper rabies vaccination </li></ul><ul><li>call home … and me! </li></ul>
  23. 64. Malaria
  24. 65. Malaria: The Key Points <ul><li>there are 4 species of malaria </li></ul><ul><li>only one of them, Plasmodium falciparum, can be fatal </li></ul><ul><li>this is the one you will be exposed to </li></ul><ul><li>malaria is likely OVERDIAGNOSED in the tropics </li></ul>
  25. 69. <ul><li>FEVER </li></ul><ul><li>headache </li></ul><ul><li>chills </li></ul><ul><li>aches and pains </li></ul><ul><li>hot and cold </li></ul><ul><li>diarrhea </li></ul><ul><li>FEVER </li></ul>
  26. 70. 38.5
  27. 71. Malaria prophylaxis for CRFM <ul><li>mefloquine ( Lariam ) </li></ul><ul><li>doxycycline </li></ul><ul><li>atovaquone / proguanil ( Malarone) </li></ul><ul><li>primaquine </li></ul>
  28. 72. Mefloquine ( Lariam ) <ul><li>Dosage </li></ul><ul><ul><li>begin 1 week prior to exposure, weekly while take exposed, and for 4 weeks after </li></ul></ul><ul><ul><li>take with lots of food and water … not alcohol </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>seizure disorder </li></ul></ul><ul><ul><li>cardiac conduction disturbance </li></ul></ul><ul><ul><li>“ psychiatric” problems – anxiety, depression </li></ul></ul><ul><ul><li>bias or past adverse effects </li></ul></ul><ul><ul><li>“ OK” in pregnancy </li></ul></ul>
  29. 73. Mefloquine ( Lariam ) <ul><li>Adverse effects </li></ul><ul><li>GI upset (take it with food and water, not OH ) </li></ul><ul><li>dizziness </li></ul><ul><li>insomnia </li></ul><ul><li>dreams (vivid – erotic, exotic or frightening) </li></ul><ul><li>anxiety, depression </li></ul><ul><li>psychosis </li></ul><ul><li>seizures </li></ul>
  30. 88. Stop worrying about the potholes in the road and celebrate the journey!
  31. 90. Doxycycline <ul><li>Dosage </li></ul><ul><ul><li>100 mg daily – begin day before exposure, daily while exposed, and for 28 days after exposure </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>under the age of 8 </li></ul></ul><ul><ul><li>pregnancy </li></ul></ul>
  32. 91. Doxycycline <ul><li>Side effects </li></ul><ul><li>photosensitivity </li></ul><ul><li>yeast infections </li></ul><ul><li>gastrointestinal problems – diarrhea, heartburn </li></ul>
  33. 92. Malarone (atovaquone / proguanil) <ul><li>Dosage </li></ul><ul><li>one tablet daily – begin one day before exposure, daily while exposed, and for 7 days after exposure </li></ul><ul><li>Contraindications </li></ul><ul><li>sensitivity to either component </li></ul><ul><li>pregnancy </li></ul>
  34. 94. Malaria Mythconceptions <ul><li>the drugs are worse than the disease </li></ul><ul><li>the drugs only mask the disease </li></ul><ul><li>antimalarials should not be taken for a long time </li></ul><ul><li>once you have had malaria, you’ve got it forever </li></ul><ul><li>all of those “horror stories” will happen to me </li></ul><ul><li>your hair will fall out – maybe, but it will grow back! </li></ul><ul><li>if you drink enough gin and tonic, you won’t get malaria! </li></ul>
  35. 95. Treatment of malaria <ul><li>quinine sulfate + doxycycline </li></ul><ul><li>Malarone 4 tabs a day x 3 days </li></ul><ul><li>Artemesinin ( Riamet , Cotexcin , Arsumax , Coartem, Alaxin, Artenam , Arinate, Artesunate ) x 5 days + doxycycline or Fansidar </li></ul>
  36. 97. What if you think you have malaria??? <ul><li>seek medical care ( fymcbyni ) </li></ul><ul><li>have a malaria test </li></ul><ul><li>take the proper medication </li></ul><ul><li>get all better </li></ul>
  37. 98. Both diarrheal illness and febrile illnesses will be treated on speculation Understand the appropriate treatment and medications for these problems.
  38. 102. Don’t swim in fresh water
  39. 103. If you’re climbing Kilimanjaro, call me or read Chapter 10!
  40. 106.
  41. 108. <ul><li>ANY QUESTIONS?????? </li></ul><ul><li>if you need me, send me an e-mail, don’t text me, </li></ul><ul><li>at [email_address] </li></ul><ul><li>Have fun! </li></ul>
  42. 111. FAQs regarding Traveller’s Diarrhea <ul><li>For how long do you boil your water? </li></ul><ul><li>Can I brush my teeth in the tap water? </li></ul><ul><li>Can I take a shower? </li></ul><ul><li>If I drink local water for the first month, will I develop immunity like the locals? </li></ul><ul><li>What can I do about the iodine taste? </li></ul><ul><li>Isn’t it better to let the “bugs” get out of me? </li></ul><ul><li>Isn’t Imodium is bad for you? </li></ul><ul><li>Aren’t the ice cubes with the holes OK? </li></ul><ul><li>What about Pepto Bismol , acidophilus, charcoal pills, grapefruit seed extract … </li></ul>
  43. 114. <ul><li>what is it? </li></ul><ul><li>how many different strains are there? </li></ul><ul><li>what are the symptoms? </li></ul><ul><li>what do you do if you think you have it? </li></ul>
  44. 117. Doctor, it is me again. I woke up at 4 in the morning with a high fever, my body was shaking, I had a horrible headache and a temperature of 102 o F/ 40 O C. I have been taking my malaria pills. You must have malaria young man. Here, take these seven pills. Can you do a malaria test, Doctor. Maybe I have something else, like typhoid or dengue. We do not have such tests. They are too expensive. If you aren’t getting better, you will come back to see me. Which one is artemesinin, or quinine? The little package called Coartem/ Riamet / Alaxin / Artesunate …. Thank you Doctor. My fever is coming down already!
  45. 118. Hello Doctor. I can’t stop running to the latrine. I have fever, chills and cramps. Thank you Doctor. The cramps are getting better already! Sounds like you have diarrhea. Why don’t you take these seven different pills. Which one is ciprofloxacin, Doctor, as Doctor Mark told me that this is probably caused by a bacteria? Ah, you must be with VSO. The white one is Cipro. Take that for 3 days, drink lots of clear fluids or ORS, and maybe take an Imodium.
  46. 119. Two weeks later …. Hello again Doctor. I felt better after our last visit. But now, for the past 3 weeks, my stools have been loose on and off, I have lots of gas and I can’t stop farting. Thank goodness! Here, take these 7 pills and you will feel better. Which one is metronidazole or tinidazole, Doctor, as Dr. Mark said that persistent symptoms like this might be due to a parasite? Oh yes, the VSO guy. It is the yellow one. Take it for 7 days, and you will feel better. Forget the rest. Thank you Doctor, the farting is letting up already.
  47. 122. It’s only your sixth day in Ghana, and already you have the runs, and fallen in two sewers! Let’s talk about it, while you get ready to run to the can again! <ul><li>what are the causes of travellers’ diarrhea? </li></ul><ul><li>from what do you get infected? </li></ul><ul><li>how can you try to avoid this catastrophe? </li></ul><ul><li>what do you do if you do get diarrhea? </li></ul>
  48. 125. chloroquine mefloquine doxycycline Malarone
  49. 130. HIV/AIDS Workplace Policy <ul><li>The objectives of the policy are to: </li></ul><ul><li>Give consistent international policy direction to all VSO staff and volunteers on providing a supportive work environment for those infected and affected by HIV & AIDS. </li></ul><ul><li>Ensure that the needs of staff and volunteers with respect to HIV & AIDS are balanced with the needs of the organisation to deliver its strategic objectives and are affordable. </li></ul>
  50. 133. The greatest risk? 1% snakes 2% alcohol 4% diet 5% safety 4% nothing 4% pollution 4% STD / HIV 4% stress 11% malaria 8% medical care 14% food and water 41% roads
  51. 136. What to do when you’re sick … local doctors local consulate air ambulance service local NGO office head NGO office family