Joey Wahler (Host): They can help keep you healthy during a trip abroad. So, we're discussing the Travel Health Clinic at MIT. Our guest is Pauline Yee. She's a registered nurse and Travel Nurse Advisor, Program Manager for MIT Health.

This is Conversations with MIT Health. Thanks for joining us. I'm Joey Wahler. Hi, Pauline. Welcome.

Pauline Yee, RN: Hi, Joey. Thank you for having me.

Host: Great to have you aboard. We appreciate the time. This is an interesting conversation because this is something that's not offered everywhere. It is offered by MIT. But first, how long have you been with MIT Health?

Pauline Yee, RN: I've been with MIT for 11 years. I've been working with them as a travel health nurse, and it's been going well. I enjoy it.

Host: That's great. Now, the Travel Health Clinic at MIT really provides a unique service, as we just touched on. So, give us a little overview, please, of what exactly it does.

Pauline Yee, RN: Here at the travel clinic, we provide pre-travel consults for anyone who is traveling abroad. We provide travel vaccines. We're actually one of the yellow fever centers here in the U.S. Not every travel clinic has yellow fever, so we're fortunate to have that on board. We provide service to all members of our MIT Healthcare Plan members, students, faculty, staff, and their families, whether they're traveling for pleasure, business, educational. We provide easy access, very convenient. We can do it by office visit, by telehealth, or by phone. So really, we try to make it as easy as possible for our travelers to get the services that they need.

Host: Gotcha. So, explain to people, if you would, why is it so important to have this service available to the MIT community?

Pauline Yee, RN: We find that when people are traveling, especially abroad, internationally, they could be at risk for various illnesses, anything in terms of, mosquito bites, animals, food and water precautions, safety. We want to try to keep them healthy and to be able to enjoy the destination that they're going there to serve their purpose, to enjoy the destination, and to not spend their time laying in bed or sitting in a toilet. We find that we are able to support the students and the staff to decrease their risk.

Host: Understood. Now, you mentioned a couple of things there that can happen on a trip abroad. Bites, issues with drinking the water. Do you find from your experience doing this that sometimes when people are getting ready for a big trip, especially overseas, these are things that maybe get overlooked?

Pauline Yee, RN: We find that many times, people will purchase their plane tickets last minute, and then they realize, "Maybe I should consult with a travel clinic just to see if there's medications I should bring with me or vaccines I should need to help for them to decrease the risk when they're traveling. Many times we have people who also go high altitude. They didn't realize that certain places, the altitude is very high, and we have medications and ways to help them to decrease them getting high-altitude sickness. Many times, people will go to Peru, to Machu Picchu, Cusco, where it's very high elevation and it's important to be able to take medications to prevent your high-altitude sickness.

Host: So based on your background, in order to do this particular kind of work, you really need to know not just about medicine, but about the world, right?

Pauline Yee, RN: Yes. I have gotten to know the globe and the countries much better over the years of doing the travel consult. I was trained at Mount Auburn Hospital with Dr. Chen and at Mass General Hospital with Dr. Ryan. They have taught me a lot of good skills and what to look for, what to anticipate, how to interview, how to assess with the traveler, where they're going, what activities they may be doing to try to help them to stay healthy. I'm also a member of the International Society and Travel Medicine and also the American Travel Health Nurse Association. That's where I keep my information up-to-date. We share, we connect with each other in terms of very unique questions or concerns that may be going around current events and attend conferences.

Host: And you bring up a great point there. The fact that if there's suddenly an outbreak or even something short of that in the way of any kind of a health threat in another country that Americans may be traveling to, you need to be aware of that as soon as possible, right?

Pauline Yee, RN: Yes. When COVID first hit, the traveling was very much put on hold, there was less traveling. And now, as traveling is picking up within the past year and a half, and COVID still hasn't gone away, it's still here, and people want to travel. So, how do we keep them safe? What do we tell them to do? So for the case of COVID, we ask that they should bring their COVID-19 self-test kits, some fever-reducer medications, masks, and be updated with your vaccines, your COVID vaccines.

The newest thing that has come up now is the Mpox, which is an outbreak, recently. So, that brings a lot of questions around that and things are evolving. So, trying to educate people on how to protect themselves.

Host: Absolutely. Now, you alluded a moment or two ago to interviewing people when you get together with them either in person or remotely to talk about their trip so you know what their particular needs are. Can you walk us through what a typical travel health appointment involves?

Pauline Yee, RN: Yes. Things to know from people. Usually, when they come in, we try to instruct them to eat before they come because we find that people tolerate the vaccines better on a full stomach. We would assess their background, their medical history, any allergies that they may have, any unique medical history, medications that they may be on, any medications that they may be taking with them on their travels. When will they be traveling? What would they be doing? Would they be out there climbing mountains, hiking? Or will they be in little villages interviewing people? Will they be in hospitals at risk for other illnesses that may put them at risk there? Will they be out doing researching or collecting specimens out in the field, out in the waterway system?

So, these are things that we get to know to see what their risks are. How long will they be there? Have they had any travel vaccines in the past? We also assess or instruct them on food and water precautions, mosquito-borne illnesses, bug repellent, animal precautions, water safety, other bugs that may be out there, and provide them with vaccines that they will need, travel medication, prescriptions that they will need, what to do if they get sick. Also regarding, if it's a long flight, would that put them at risk for blood clots, what to do to prevent that; any medical assistance that MIT provides, which we have a great program for that, driving, motor vehicle safety. So, those are things that we do talk about in detail when they come in. Then, we answer any specific questions that they have, then we give them their vaccines and their prescriptions, and have a great trip.

Host: That's the goal, right? So, you mentioned vaccines. Let's talk a little more in detail about that. What are some of the countries people are traveling to right now where they would need travel vaccines? And what are some of the common vaccines that are needed right now?

Pauline Yee, RN: For now, in terms of for the community here at MIT, we find that many of the students and researchers are traveling to countries like Brazil, Columbia, India, South Africa, Uganda. So many of the countries where they're going, they're doing their research, they are there to learn about the culture, the environment, and how to better improve. And in terms of the common vaccines or things that they may be at risk, yellow fever. Certain countries require a yellow fever certificate in order to get in. And being one of the centers for yellow fever, we are able to provide that to our travelers.

Hepatitis A is a common thing. Here in the U.S., it's now common for the students to receive it. But for the other folks, hepatitis A is something that is highly recommended. That's through food and water. Typhoid, we're blessed here in the U.S. where we do not have typhoid, which is a foodborne illness. Other countries, they're not as fortunate. So, we have vaccines for the travelers here to receive. And the vaccine may take 10 to 14 days for it to be effective. We also have Japanese encephalitis by the mosquitoes, depending on what they're doing. If they're out in areas where there are pigs, out in rural areas, mosquitoes can also transmit malaria. And malaria, we have no vaccines, but we have medications to help to decrease your risk for malaria.

The animals, if they're going to be working with animals, researching animals, or just happen to be out hiking out in some boondock land, rabies. We have rabies as a pre-exposure to help with that. The other things is making sure that you're updated on your routine vaccines. Many times, I find that their tetanus is outdated. It's been more than 10 years, or depending on what the activity is, they might need it to be updated sooner than the 10-year mark, just to eliminate that risk while they're traveling abroad. So, there's a lot of things that are covered for that. High-altitude sickness pills prevention to help with that too. So, those are some of the areas that we cover during the consults.

Host: Certainly a comprehensive service, a lot of things to be protected against. And it sounds like you provide all that under one roof. So, you touched on the fact that typically vaccines take a while before they take effect. So, how far in advance should someone schedule a travel health appointment, would you say?

Pauline Yee, RN: For any travel clinic or any travel health consult, ideally four to six weeks would be good. Eight weeks prior to departing would be best because some of the vaccines are two-part vaccines and they can be spaced apart one month. So therefore, coming in as soon as you buy your plane tickets. Please give us a call, come in, so then we can work with you to see how best to approach the vaccines that you may need for the travel. We find sometimes that you may need up to five vaccines. If we are in here more in advance in time, we can spread them out. Otherwise, you're getting all five. That's a tough deal to deal with.

Host: That's a good warning right there. A couple of other things. If a group from a specific MIT department, a lab, or center is traveling together, I would imagine that's the case in certain instances, can they do their travel health consultations as a group together?

Pauline Yee, RN: Funny, you should bring that up. Definitely, we can. So here at MIT, we have many large groups. We have the sloan students from the business school. We have MISTI, where we send students out abroad to do various projects. We have Terrascope, where also student clubs travel for pleasure. So, we do provide education via Zoom classrooms. I attend the student fairs to share the information. And we do the consultation. And if people do need to get vaccines, then they would have to come in for an appointment in order to receive the vaccines. And we have also done a large clinic where there was a large group of students traveling to Morocco, and we held a large clinic where we had many of the support staff in-house to administer the vaccines that they needed. So, we do do that. And I'm in contact with many of the leaders here on campus who do a lot coordinating the travels. So, they provide advance notification to us. And then, we try to work out on a schedule where we can meet everyone's needs.

Host: And then, you mentioned earlier, Pauline, that this is open, this service, to anyone from the MIT community. So, what if, for instance, someone's traveling with their family, how does that work?

Pauline Yee, RN: So, the MIT Travel Health Clinic is open to all members who are on our MIT Health Plan. That's the students, the faculty, the staff, and their family members. And as long as they're on the MIT Health Plan, they're qualified to come in to be seen. For people, staff who are not on the health plan, but they're traveling for MIT business, they can also come in and utilize our services.

Host: And then, in summary here, you touched on this earlier as well, how can those traveling through you and yours best prepare in case, if it happens, they do get sick while on a trip abroad?

Pauline Yee, RN: So for members of MIT, we have the International SOS, which is a health medical assistance. Should one, when they're traveling, if they have any medical concerns, any security concerns, you will contact them and they will be able to help you locally or abroad where you are.

In general in terms of if you were to get sick or to prepare in case if you get sick, you want to bring some over-the-counter fever-reducing medicine like Tylenol, COVID-19 self-test kit, masks. If you have any allergies, if you have an EpiPen, you want to bring your EpiPen with you. Bug bites, anything that you may use here at home in case of after you get a bug bite, any after-bite topical ointments would be suggested. Diarrhea, that's something that we try to avoid, but sometimes it does happen when one travels. So, we ask people to bring over-the-counter, anti-diarrhea medications like Imodium, Pepto-Bismol. For a certain small group of travelers, they may qualify to get antibiotics and we will prescribe them antibiotics just to have it on hand. Antibiotics is not something that we prescribe in general, because of the increased antibiotic-resistant bacteria, so that is not good, but we are working on that. Remaining hydrated. Drinking clean water. Making sure the water is truly clean, boiled, purified, or truly sealed in a bottled water both for brushing your teeth and for consuming.

Host: Great advice indeed, Pauline. Folks, we trust you're now more familiar with MIT's Travel Health Clinic. Pauline Yee, safe travels to you and yours. Keep up the great work and really interesting stuff. Thanks so much again.

Pauline Yee, RN: Thank you for your time.

Host: Same to you. And for more information or to connect with a provider, please visit health.mit.edu/services/travel-health. For more health tips and updates, please follow MIT Health on your social channels. Please also remember to subscribe, rate, and review this podcast and all the other great MIT Health podcasts as well.

If you found this one helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of Conversations with MIT Health.