Exotic Spots Call for a Specialist's Care

If your travel health needs are simple--say, you're trying to get through a flight to Chicago without arriving at the family reunion with your head too congested to gossip--all you'll probably need is a trip to a primary care provider.

But suppose you are traveling to a developing country, or to a destination where an outbreak of disease is making news, or you have a chronic medical problem such as diabetes. In that case, you might consider seeking help from a specialist in travel medicine.

If you're going to an exotic destination or taking an adventure trip, find out whether you will need immunizations. You can find current information on the Centers for Disease Control and Prevention Internet site, http://www.cdc.gov/travel. This is also a good site for you or your family physician to check if you develop symptoms of illness upon returning to the U.S.

It's a good idea to discuss your travel plans with your doctor first, says Dr. Terri Rock, a Santa Monica family practice physician who specializes in travel medicine. The primary care physician might be able to provide the immunizations you need and can advise you on complications that travel might pose for your chronic health problems.

Or your doctor might advise you to see a travel medicine specialist, especially for complicated immunizations.

Finding a well-trained travel medicine physician may take some work. Exactly who is qualified to call himself or herself a travel medicine specialist? And where can you find a good one?

There's no board certification as yet in travel medicine, as there is in many other specialties, such as internal medicine and dermatology.

The field of travel medicine is growing, spurred by corporations sending workers overseas and the growth of leisure travel to exotic destinations. Providing travel medicine services can be lucrative. And because any licensed physician can call himself a travel medicine specialist, it's buyer beware.

One clue that a travel medicine specialist knows his stuff is membership in the American Society of Tropical Medicine and Hygiene or the International Society of Travel Medicine.

The ASTMH offers a training program for health care providers, culminating in a certificate. Before taking the exam, applicants must complete a course in tropical medicine at an approved institution and must have cared for patients in the tropics for at least two months.

The ISTM is working on a certification track and will focus on travel medicine rather than tropical medicine.

"In about two years we expect the first group of certificated doctors," says Dr. Bradley Connor, a New York travel medicine specialist who is on the society's executive board.

Both organizations maintain Web sites with lists of members who are travel medicine providers in the U.S. and abroad: http://www .astmh.org and http://www.istm.org. Some health care providers belong to both groups.

To find one with experience, ask how long he or she has been providing travel medicine services.

Connor recommends at least three to five years' experience, with a patient load of at least 20 a month.

Healthy Traveler appears twice a month. E-mail: kdoheny@compuserve.com.

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