Services

The Travel Clinic offers the following services:

• Individualized health consultations (which includes current recommendations from the Centers for Disease Control ,International Society of Travel Medicine , WHO and Travax)
• All recommended and required immunizations and International Certificates of Vaccination
• Prescriptions and information for prevention of malaria and other illnesses
• Up-to-date health and travel advisories and handouts
• Update your immunization statues .
• Management of chronic diseases before , during and after the travel .
• Special consideration for children , elderly , special needs and pregnant women .
• Consultations for various adventures ( climbing mountains , diving , safari … etc ) .

The Pre-Travel Consultation:

Pretravel consultation is very important for all travelers , in the travel clinic the doctor will
take a detailed past medical history ( age , sex chronic diseases , medications … )
, special conditions (Pregnancy, Breastfeeding , Disability or handicap , Immunocompromising conditions
or medications , Older age , Older age , Seizure disorder , Recent surgery … ) ,
immunization history (Routine vaccines , Travel vaccines ) , Prior travel experience
( Experience with malaria chemoprophylaxis , Experience with altitude , Illnesses related to prior travel )
, Trip Details (Itinerary, Timing, Reason for travel, Travel style, Special activities.
immunization (Review routine immunizations and those travel immunizations indicated for the specific itinerary
, Discuss utility of titers when records are unavailable or unreliable , Discuss indications for,
effectiveness of, and adverse reactions to immunizations. ) , Malaria chemoprophylaxis. Discus other problems :
Other vector borne diseases
Respiratory illnesses
Travelers’ diarrhea
Altitude illness
Other environmental hazards
Personal safety
Sexual health and blood borne pathogens

Self-Treatable Conditions
Prescribing certain medications in advance can empower the traveler to self-diagnose and treat common health problems, Travel health providers need to recognize the conditions for which the traveler may be at risk and educate the traveler about the diagnosis and treatment of those particular conditions, Examples: 
Travelers’ diarrhea, Altitude illness, Jet lag, Motion sickness, Respiratory infections, Skin conditions, Urinary tract infections, Malaria self-treatment.

Basic health travel kit is recommended:
Consider having a list of medications along with a medical attestation signed by a physician authenticating the need of those medications for personal use. The kit should include:

• Antiseptic wound cleanser , Antihistamines ,Wound coverings , Adhesive bandages, medical tape, sterile gauze ,Eye drops, Nasal decongestant ,Hand antiseptic , Insect repellent/insect bite treatment ,Oral rehydration powder ,Scissors, safety pins/closure devices , Simple analgesics (eg, ibuprofen, acetaminophen), Thermometer (oral/rectal)

Additional considerations include the following:

• Antidiarrheal medication , Antinausea medication (if any water travel or winding roads anticipated) , Antifungal medication , Malaria prophylaxis (based on travel-clinic and/or CDC recommendations depending on destination) ,Personal medications (current medical conditions) , Sleeping medications/sedatives ,Water purifier/disinfectant .

Vaccination and Immunization
Scheduling a visit to one’s doctor or a travel medicine provider is essential—ideally 4-6 weeks before the trip because most vaccinations require a period of days or weeks to become effective..  We have 3 vaccines categories:
Routine vaccinations: Routine vaccinations are the immunizations that are routinely provided as a part of one’s normal health maintenance (eg, tetanus immunization). These vaccines need to be updated before travel.
Recommended vaccinations: these vaccinations are recommended to protect travelers from illnesses present in other parts of the world and to prevent the importation of infectious diseases across international borders. Special considerations for aging, immune compromised, pregnant, chronically ill, students, and disabled travelers are essential.
Required vaccinations
Like yellow fever vaccination for travel to certain countries in sub-Saharan Africa and South America. In addition, those traveling during the Hajj are also required by the government of Saudi Arabia to obtain the meningococcal vaccination.

Cruise Ship Medicine
Today, most cruise ships require a ship physician to have some emergency medicine experience.
Common medical conditions in cruise ships include the following:

• Sunburn , Alcohol intoxication , Seasickness , Upper and lower respiratory infections , Diarrhea and subsequent dehydration , Minor orthopedic injuries , Geographic specific illnesses , Exacerbation of common medical illnesses , Major orthopedic injuries, cardiac, diabetic crisis, and cerebrovascular accident (CVA) are not uncommon

People planning cruise ship travel, especially those older than 65 years, those with acute or chronic illnesses, or those who are pregnant or breastfeeding should consult with a health care provider prior to travel for advice.

How flying affects your health and what you can do to combat it?
Airsickness:
Is a sensation which is induced by air travel , It is a specific form of motion sickness, nausea and vomiting , the travelers advised not to eat before the travel if they have this condition  and it can be treated with some medicines .
Sickness
The increased risk of catching a cold is more than 100 times higher on a plane. The travelers advised to use alcohol based gel to clean their hand and the chair arms.
Deep Vein Thrombosis

Breathing difficulties
The pressure in an airplane cabin at cruising altitude may make you feel like you are high in the mountains. There's less oxygen available which puts an added load on a system trying to get the required amount of oxygen into the bloodstream. 
Hearing problems
The human ear can tolerate 88 decibels for four hours and 85 decibels for eight hours, the noise on the plane usually 95-105 decibels (115 during take-off), the noisier par is the back, so you are at risk of hearing damage or hearing loss, and the more you fly, the greater the risk .avoid the noisy places, move around and use the noise-reducing headphones (can cut noise by up to 40 decibels).
Reduction in taste
To taste salty and sweet can drop by as much as 30 percent in-flight. This is because plane air dries out the mucous membranes in your mouth. The solution? Stay hydrated, and stick to sour, bitter, and spicy foods, tastes that are much less affected
Jet lag
Jet lag is part of long flights. Short-term problems from jet lag include fatigue, loss of concentration, irritability and loss of appetite. Consistent disruption of body rhythms could lead to cognitive decline, psychotic and mood disorders and possibly heart disease and cancer. What can we do? :

• A relaxed flight is important.
• Avoid travelling when you are already tired and take rest before departure.
• Remember the actual travelling time will usually be at least twice the actual time spent in the air since it will include travelling to and from and hanging around in airports.
• Avoid heavy commitments on the first day. Be prepared for tiredness in the evenings and early waking which can last up to 5 or more days.
• Sleeping tablets will help you to sleep and be correspondingly alert during the next day but they do not speed up adjustment to the new time zone.

Radiation
On most international flights, you are exposed to a not entirely insignificant dose of radiation from cosmic rays, which are energetic particles from space. 
The longer the flight and the higher and closer you fly to the North Pole, the greater the dose,
Scientists say for the average tourist the levels are too low to worry about.
Constipation
All that sitting causes your metabolic rate and digestion to slow, and causes gas, bloating, and constipation. 
Suggestions to avoid it include cutting down on your calorie intake and twist from side to side in your seat to help everything keep moving, Drink a lot of water, and avoid alcohol and caffeine. But don't even think of drinking water unless it's bottled.
Bad Breath
Due to reduction in saliva production, which allows bacteria to flourish.Food particles left in the mouth produce a Sulphur compound and cause bad breath, and over-doing it with sugary drinks, fast food, and sweets also encourages halitosis. Just as you would at home, eat healthily, drink water and brush your teeth.

Conditions that might cause problems during air travel include:-

• Pregnancy beyond 36 weeks.
• New born babies during the first few days after birth.
• Recent or current middle ear infections or sinusitis.
• Unstable psychiatric illness or epilepsy.
• Recent myocardial infarction or moderate/severe heart failure.
• Recent chest, intra-cranial or abdominal surgery.
• Recent pneumothorax or moderate to severe hypoxic pulmonary disease.
• The presence of a communicable disease.
• Previous record of causing disruption during flights.

General advice for travelers

• Prepare a plan for your travel
• Visit your doctor (travel medicine travel), preferably 3-4 weeks (minimally 10 days) before travel.
• Use antiseptic (alcohol based gel) in the airport and the airplane.
• 4 – Avoid the raw food (like salads, mixed fruits) and eat only the well cooked food, avoid sea food if possible.
• Drink only the bottled water and make sure the bottle is sealed. Avoid the use of local ice cubes.
• Don`t swim in the lakes or the rivers , when you swim in the sea use the sunscreen and above it apply the mosquito repellent if indicated .
• Don`t walk outdoor without shoes.
• Take all the precautions against the mosquitoes ( mosquito repellent , mosquito net , keep the doors and windows closed , search the room carefully for mosquitos and kill them before you sleep , wear long sleeve and light color cloths  . )
• Avoid the crowds and the risky places.
• Respect the traditions and the culture of the people in the country you are visiting.
• Keep a safety distance from animals.
• If you are going safari or adventures in the jungle or the mountains wear a long stockings or long boot to avoid ticks bite.
• If you have a wound or animal bite, wash it thoroughly with water and soap for 5 minutes and seek medical advice.

Eat and drink safely
Counsel travelers to be diligent about food and water precautions:

• Avoid cooked food served at room temperature.
• Avoid raw food, including raw vegetables unless they can be washed thoroughly.
• Drink only beverages from sealed bottles or cans.
• Water is safe if it has been boiled or chemically treated.
• Avoid ice unless made from bottled/disinfected water.

Consider prescribing an antibiotic for self-treatment of travelers’ diarrhea, factoring in resistance issues at the destination.

Prevent bug bites
Counsel travelers to be diligent in insect precautions:

• Cover exposed skin.
• Use an appropriate insect repellent. (see below)
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Travelers can buy pre-treated clothing and gear or treat them at home. Treated clothing remains protective after multiple washings. Permethrin should NOT be used directly on skin.
• Stay and sleep under in air-conditioned or screened rooms.
• Use a bed net if sleeping area is exposed to the outdoors.

More Information on Insect Repellents
DEET (concentration of 20% or more) is the only insect repellent shown to be effective against ticks. However, several EPA-registered active ingredients provide reasonably long-lasting protection against mosquitoes:

• DEET (chemical name: N,N-diethyl-m-toluamide or N,N-diethyl-3-methyl-benzamide): Concentrations above 50% show no additional protective benefit.
• Picaridin (KBR 3023 [Bayrepel] and icaridin outside the United States; chemical name: 2-(2-hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl ester): Must be reapplied more often than DEET.
• Oil of lemon eucalyptus (OLE) or PMD (chemical name: para-menthane-3,8-diol), the synthesized version of OLE. “Pure” oil of lemon eucalyptus (essential oil) is not the same product; it has not undergone similar testing for safety and efficacy, is not registered with EPA as an insect repellent, and is not covered by this recommendation.
• IR3535 (chemical name: 3-[N-butyl-N-acetyl]-aminopropionic acid, ethyl ester).

Products with <10% active ingredient may offer only limited protection (1–2 hours).
Encourage patients to use repellents and reapply only as instructed. If sunscreen is also needed, they should apply sunscreen first and repellent second. Encourage them to follow package directions for using repellent on children and avoid applying to their hands, eyes, and mouth.

Stay safe outdoors
Advise travelers to exercise caution during outdoor activities. Important tips include dressing appropriately for the climate (such as loose, lightweight clothing in hot climates and warm layers in cold climates), staying hydrated, avoiding overexposure to the sun, and practicing safe swimming habits. To avoid infection while swimming, travelers should not swallow water when swimming and avoid contact with water that may be contaminated from poor sanitation.
Encourage travelers to learn basic first aid and CPR before travel, especially if they will be traveling to remote areas where medical assistance may not be accessible. Help them assemble a travel health kit.
Leptospirosis is endemic in Sri Lanka. Travelers should avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.

Keep away from animals
Counsel travelers to be cautious around all animals.

• Travelers should avoid touching, petting, handling, or feeding animals, including pets.
• Arthropods such as spiders and scorpions can pose a stinging risk, and travelers should exercise care in environments where these creatures are likely to be present.
• Stress the urgency of treating suspected and probable rabies infection by:
• Washing the wound immediately with soap and clean water.
• Seeking medical attention as soon as possible.
• Travelers at risk for rabies should consider medical evacuation insurance, since postexposure prophylaxis may not be available at the destination.

Reduce your exposure to germs
People who are ill should not travel. Urge travelers to practice hand hygiene and sneeze into a tissue or their sleeve.

Avoid sharing body fluids
Counsel travelers on the risks of diseases associated with the exchange of saliva, blood, vomit, semen, urine, and feces.
Travelers should:

• Use a latex condom correctly every time they engage in sex (vaginal, anal, and oral-genital).
• Not inject drugs.
• Limit alcohol consumption.
• Not have tattoos, piercings, or other procedures that use needles (acupuncture) unless the needles are packaged new or sterilized.
• Ensure that medical and dental equipment is sterile or disinfected if seeking care.

 

Know how to get medical care while traveling
Travelers should plan for how to obtain health care during their trip, should the need arise.
Discuss supplemental travel health insurance and medical evacuation insurance, and consider helping the traveler obtain an extra month of prescriptions for any needed medications.
Travelers may think they can find cheaper antimalarial drugs at their destination. To ensure medication quality, urge them to have their prescriptions filled in the United States.

 

Select safe transportation
Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.
Most recommendations for safe transportation are basic and could be considered common sense. However, travelers often do not think about the importance of being aware and careful when walking, riding, driving, or flying.
In many places cars, buses, large trucks, rickshaws, bikes, pedestrians, and even animals share the same lanes of traffic, increasing the risk for crashes.
Counsel travelers to think about transportation options before they arrive, especially if they will be driving in Sri Lanka.
Medical Evacuation Insurance
If your patient is seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Encourage patients to purchase medical evacuation insurance.
Some basic reminders to review with your patients:

• Choose safe vehicles and avoid motorbikes when possible.
• Wear a seatbelt or a helmet at all times.
• Do not drive after drinking alcohol or ride with someone who has been drinking.
• Avoid driving at night; street lighting in certain parts of Sri Lanka may be poor.
• If they will be driving, remind them to get any driving permits and insurance they may need. It is recommended to get an International Driving Permit (IDP).
• Avoid using local, unscheduled aircraft, and fly on larger planes (more than 30 seats) when possible.

 

Maintain personal security
Travelers should be reminded on how to protect their personal safety during travel, regardless of their destination. 
The US Department of State has an extensive website with safety information for international travelers, travel alerts and warnings, and country-specific information. Travelers should be directed to the Department of State resources for information and tips on safe travel.
Stay abreast of current events, particularly those that could pose a safety or health problem for travelers.