Cheryl Martin (Host): Globetrotters can face some common health risks when visiting tropical or developing regions. So, coming up, we delve into the crucial role of travel medicine and learn all about it with Dr. Marcelo Gareca. He's a renowned Infectious Diseases specialist at Guthrie Clinic.

This is Medical Minds: Conversations with Guthrie Experts, a podcast from the Guthrie Clinic. I'm Cheryl Martin. Glad to have you on, Dr. Gareca.

Marcelo Gareca, MD: Glad to be on. Thank you for the invitation.

Host: So, what exactly is travel medicine and why is it an essential consideration for anyone planning to travel?

Marcelo Gareca, MD: Well, thanks again for inviting me. And I think this is a great topic and is one of my loved topics. So, travel medicine involves the preparation of a traveler pre and post travel. We like to have all the good times when we're overseas. And sometimes we think about passports, we think about tickets, we think about hotel reservations, and we don't think about other possible inconvenience or even complications that can happen during travel times, particularly when you're going to rural areas or some tropical areas and underdeveloped areas. So, our job is to prepare the travelers, not only with vaccinations, but with advice so everything goes smoothly. And sometimes we see the patients after they come back from the travel for a followup visit in the case that a complication did happen or some situation evolved when they were away.

Host: So, doctor, what are some of the most common health risks that travelers face, particularly those venturing to tropical or developing regions?

Marcelo Gareca, MD: Each area of the world has particular concerns. And one of the things that we like to see with the patient is find out exactly what their itinerary is going to be. But very briefly, tropical areas tend to have malaria and tropical areas tend to have other mosquito-borne diseases, including yellow fever. So, some of those areas, they're required to take malaria tablets, some of them you need to require malaria tablets after you leave the area, and some of them require yellow fever vaccination. There are some countries in Latin America and particular in Sub-Saharan Africa that will not issue a visa unless you have a yellow fever vaccination. So, that is one of the biggest concerns.

For pilgrim and religious traveling, particularly to the Hajj, during the high migration to Mecca, the government of Saudi Arabia requires some particular vaccinations. So, it depends where you're traveling and when you're traveling. And even which part of the country are you going to be visiting? You may require different vaccinations or medications.

Host: And so, that leads to the question, the significance of pre travel consultations. How far in advance should a traveler meet with a provider locally, and what do pre-travel consultations typically involve?

Marcelo Gareca, MD: Fantastic question, and I know we don't have the time to go into all the details. But we would like to see patients a good month before they travel. Two weeks is the bare minimum for some of these vaccinations. I think a month before travel is a better time. But if for whatever reason you are pressed to travel earlier, just call us. We'll try to work with you. The advice is going to be tailored to your trip. So when you come to visit us, we review your trip, your itinerary, what exactly are you going to be doing, where are you going lodging? Is it going to be rural? Is it going to be cities? Are you going to be doing medical care? Are you going to be just going for business? So, we're going to spend some time into that. We're going to also spend some time in your underlying medical conditions. Do you have diabetes? Do you have heart disease? Do you have kidney disease? Do you take particular medication that can make your immune system more prone to develop these complications when you're away. And we're going to take a very close look at your vaccination records. Are you due for some update in your regular vaccinations? Are you due for seasonal vaccinations like COVID or flu? And should you get some special vaccination at the destination that you're going? So, we'll review the trip schedule. We will review the past medical history and the vaccination history.

Host: Now, once they have an itinerary and before they book a pre-travel consultation, should the traveler do some legwork and go to find out, "I'm going to this country, let me see if the state department or other websites list vaccinations or things that I need to be concerned about in terms of medicine and travel?" Or will they find all that out at the pre-travel consultation?

Marcelo Gareca, MD: Right. We'll do the homework for you.

Host: Okay. Great.

Marcelo Gareca, MD: Because it's confusing, it's gotten better since post-COVID. But during COVID, it was a moving target all the time, what the countries are requiring or not requiring, which agencies, and so on. And some of them could be left up to interpretation. It's our job. What we require from patient is as much as the vaccination records that they can get us, that's always a little bit of a stumbling block, and a medical history and a good itinerary. So if we have a good itinerary, we can work from there.

Host: Now, is there anything else you want to add regarding the importance of vaccinations and preventive medications in terms of warding off diseases that travelers can protect themselves against?

Marcelo Gareca, MD: I think sometimes we spend a lot of time and large amounts of money in the preparation of the trip. We have tickets and then we buy insurance for the tickets and you do all the research about the best hotels and the best outfitters and so on. And we tend to leave behind or we tend not to want to spend more money on the medical aspect of this. So, I ask people to reconsider how much time and effort they have expended to prepare the trip. And it would be very sad and quite costly if the trip gets complicated with a preventable disease while you're away.

Host: Do you recommend a pre-consultation if someone's going on a cruise?

Marcelo Gareca, MD: Again, it all depends where the cruise is going to be going. If the cruise is going to be going, let's say, just European countries, most likely not. But if the cruise is going to be touching ports in several South American or African countries or even Southeast Asian country, yes.

Host: Okay. I'd love for you to give us some general advice on how travelers can stay healthy during their trips. For example, any advice, best food safety tips, personal hygiene practices?

Marcelo Gareca, MD: Right. So, one of the mantras of traveling, particularly in third-world countries, if it's not boiled, if it's not cooked, if it's not wrapped, don't eat it. So, most of the trouble people get is when they're trying to try the local cuisine or the night market food, that's when problems develop. So, anything that is raw, that is not cooked, unless you are in a very well known international hotel, and even so sometimes, it might just not be worth the trip. If you think you're going to be away for a week and you're sick three or four days of that week, that's 40-50% of the time you're going to be away. So, that's a very common recommendation. We DEET and protect against mosquitoes. There are other products such as DEET. It's also part of the recommendation. And always have a list of your medications, if you're taking medications, that you carry with you just in case you need to visit a doctor or hospital when you're away.

Host: What about personal hygiene practices?

Marcelo Gareca, MD: We go over that as well. It doesn't hurt to be a little bit more careful about washing your hands or using hand sanitizers when you are overseas. It's not a bad idea to have in your backpack always a bottle of Purell or some other brand of alcohol-based hand sanitizers. Then, we have to go into details of where you're going to be. Are you going to be camping? Are you going to be in a hotel? Are you going to be in an all-inclusive? Are you're going to have access to a shower or your only option is going to be to go and bathe in a creek? So, that is more particular to each traveler.

Host: You know, I'm glad we're having this conversation, because you're really encouraging people to be proactive and look at what you can do to prevent any medical issues. Because a lot of times, health insurance doesn't always cover you when you travel abroad.

Marcelo Gareca, MD: It doesn't. That's something we'll go into quite detail, particular as we get older. And particularly for those patients that have medical conditions, we spend some time reviewing that. I also would like to put a pitch for the importance of reviewing safety. The number one reason why people die when they're traveling overseas is not an infectious disease cause, it's a trauma. And as you know, we all become a different person when we're overseas. You could be the most cautious helmet and seatbelt-wearer in the United States, and you step into Thailand and you get into a tuk-tuk, or you rent a moped in Vietnam. So, we spend a lot of time about emphasizing safety as a part of the pre-travel education.

Host: Anything else you'd like to add?

Marcelo Gareca, MD: I think it's money well-spent to come and visit a doctor prior to your trip, particularly if you're going to be going independently, not part of a tour, to third-world countries or underdeveloped countries as well as tropical places. And I think we would love to see patients earlier, a month before the travel. We can see them with time pressure in particular situations. But we also offer the opportunities to see them with their return if they happen to come back with some medical problems, anywhere from rashes and mosquito, animal bites exposure, as well as diarrhea. So, we offer the full spectrum. I'm not only an infectious disease doctor, but I went on to take special courses. I'm certified by the International Society of Travel Medicine in Travel Medicine. So, I have expertise in Tropical Diseases as well as in Travel Medicine.

Host: Marcelo Gareca, such great information. Thank you for giving us a comprehensive guide for our health needs when traveling abroad. Thank you.

Marcelo Gareca, MD: Thank you very much. Have a good day.

Host: To learn more, visit guthrie.org/travelmed. That's guthrie.org/travelmed. If you found this podcast helpful, please share it on your social media. And be sure and check out the entire podcast library for other topics of interest to you. This is Medical Minds: Conversations with Guthrie Experts, a podcast from the Guthrie Clinic. Thanks for listening.