A First Stop For Intrepid Travelers

Andy Heiskell will soon embark on the trip of his dreams to the ancient kingdom of Lo, deep in the Himalayan Mountains of Nepal. In November, the 55-year-old portfolio manager for Mutual of America in New York will fly to Kathmandu, then make two short hops by plane to the village of Jomsom before walking for 13 days to a remote area near Tibet. As part of his preparations, which included hiring Sherpa guides and renting ponies to haul essentials, Heiskell visited the Travel Health Services clinic in New York. "It's important to be checked out ahead of time and have all the necessary medical supplies to avoid ruining the trip," he says.

Heiskell is among the growing number of travelers who visit specialty health clinics before venturing into remote regions. About 350 such facilities are operating in the U.S., up from 20 about 10 years ago, says Dr. Bradley Connor, a gastroenterologist and medical director of Travel Health Services (212 734-3000). He also heads the International Society of Travel Medicine (www.istm.org). Most clinics are for-profit operations, and some are affiliated with hospitals. Their doctors range from general practitioners to infectious disease experts.

Travel clinics offer more than vaccinations. Patients receive consultations on reducing risks from food, water, parasitic diseases, and insect-borne illnesses such as malaria and dengue fever. They get advice on fighting jet lag and preventing altitude sickness. They learn how to pack an emergency medical kit--including everything from antibiotics to sterile syringes. And people with HIV or other serious conditions get care tailored to their needs. Fees range from $50 to $70, plus vaccinations, prescriptions, and medical supplies. While patients or their employers often foot the bill, some health insurers pick up costs.

Civil engineer Lamar Kinghorn recently visited the University of Pittsburgh Medical Center's three-year-old International Travel Clinic before a trip to a construction site near Bombay. Nurse practitioner Barbara Bevevino warned him about the dangers of local water. She told him not to go barefoot, to avoid picking up parasites; not to go swimming at dusk or dawn, when malaria-carrying mosquitoes are most active; and always to wipe the condensed water off beverage cans before drinking from them.

The same Pittsburgh clinic helped plastic surgeon Dr. Michael Bentz and 18 other medical professionals before they traveled to Vietnam in February to treat children with facial deformities. The members of the team were vaccinated for diphtheria, yellow fever, malaria, polio, and bubonic plague.

Some clinics cater to special groups. Fifteen years ago, Park Nicollet Clinic opened a facility near Minneapolis airport, offering services to airline employees and business people (612 993- 9700). In 1991, it opened a Minnetonka branch specializing in pediatric travel care (612 993-2925). The clinic's pediatrician, Dr. Douglas Martin, notes that preschoolers are especially susceptible to diarrhea from tainted food and to respiratory diseases, such as asthma, from poor air quality.

SHADY OPERATIONS. As an emerging field, travel medicine is unregulated and has no system of accreditation. So shady operations do exist. The American Society of Tropical Medicine & Hygiene is addressing the problem by devising a course of study and certifying exam for practitioners. "You have to stay up to date in this field, since recommendations are always changing," says Dr. Claire Panosian, an infectious disease specialist at the Travel & Tropical Medicine Clinic of the University of California at Los Angeles Medical Center (310 206-7663).

In the meantime, your best bet may be to seek out a clinic connected to a respected hospital or staffed by health professionals with infectious disease or tropical medicine training (table). You can also E-mail the International Society of Travel Medicine for referrals (bcbistm @aol.com). Another good source of health information is the Centers for Disease Control and Prevention in Atlanta, which has a free travel hotline (888 232-3228) and a number for requesting faxed material (888 232-3299). With the right care, traveling to remote corners of the world need not be risky business.

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