Table of Contents
Introduction………………………………………………………………………..3
Day one Clinical Immunology
Women Travelers…………………………………………………………………..6
Women’s medical kit………………………………………………….14
Pharmacology of Travel Medicine…………………………………………….…19 Antivaccinationists………………………………………………………….…..…29
Vaccine Safety…………………………………………………………………...…31
Immunizing Health Care Personnel……………………………………………...52
Cruise ship Health……………………………………………………………….…58
Mefloquine and Madness……………………………………………………….…74
Day 2 Expedition Medicine
Skin Cancer………………………………………………………………………….79
Medical Entomology for Backpackers …………………………………….………81
Third World Dentistry (Belize and Haiti)
& Dental Emergencies in the Wilderness…………………………………….…95
Flu, Colds, ad Avian Flu………………………………………………………..….103
Cultureshock………………………………………………………………………..110
SCUBA medicine……………………………………………………………………113
Arctic Medicine Meeting……………………………………………………………120
Introduction and Welcome
Thank you for your interest in this years meeting. We have some new speakers and have divided the sessions into a clinical day and an expedition day.
Our Clinical medicine day focuses on Pharmacology and Nursing and common scenarios will be explored. Some of the topics we will be explored are very lengthy so we decided to focus on specific scenarios for general debate and use these as springboards for discussion. By this we hope that our attendees will be learn more practical issues and be able to research solutions using the reference information we have provided in this syllabus.
Jacinda Wagner is a Compounding Pharmacist with Shoppers Drug mart. She is experienced in formulating medications to allow precise doses to be delivered in new ways. She will speak on the actions of immunizations and medications used to prevent illnesses in travelers. Often many doctors and pharmacists are unfamiliar with these drugs and her talk will introduce these products. She will also host a workshop that will examine drug interactions and contraindications.
Shane Woods RN, ONH is a registered nurse wit a specialty in occupational health nursing at Red River College. Shane manages, interprets, and is responsible for health related course student’s immunization records according to WRHA guidelines and with respect to students practicing in facilities under the direction of the WRHA.
He will speak on the Immunization record required for Health Care Students at Red River College, which also includes the Mantoux test for Tuberculosis. He will also host a workshop on immunization.
Candace Corroll is an Office Manager at the Skylark Travel Medicine Clinic and frequently assists prospective travelers in obtaining information for their trips. Her talk on Women travelers will focus on short vignettes involving women travelers with diverse and unique problems. She will go over these scenarios with possible solutions. A comprehensive reference guide will be included but not emphasized during he talk. We decided to focus on the specific cases to springboard discussion and emphasize the process on how we arrived at the solutions and not the solutions themselves.
Dr Gary Podolsky is the Conference Coordinator and Director of his Travel clinic. He will cohost the workshops on the Adverse effects of Immunizations with Shane Woods and another on Anti-vaccinationists in Winnipeg. These will be a series of scenarios with emphasis on real issues and controversies that revolve around the safety and effectiveness of immunizations. We have included an extensive reference document to back up this evidence. We wish for all of our delegates to be able to use this information to help educate the general public about misconceptions about immunizations. Gary has also expressed a wish that if anyone has problems regarding vaccine issues they may contact him after the conference.
He will also later talk on “Cruise Medicine” He will explore issues of safety and health aboard cruise ships. His talk on “Dive Medicine” will be a brief overview on the injuries that occur in recreational SCUBA.
Dr Simon Trepel is Psychiatry resident who will present two lectures- “Mefloquine and Madness” and “Fears in Travelers”. He will examine specific travel related problems from the perspective of a clinical psychiatrist. This will include a critical appraisal of the literature on such issues such as mefloquine-induced psychosis, traveller’s culture shock and substance abuse among travelers. In researching psychiatry and travel we have found that although this subject has been spoken of lightly in the past there are many areas to explore in improving mental health in travellers. Simon will define these psychiatric issues for non-psychiatrists as well so that we all may communicate these important discoveries to our own patients.
Dr Richard Heyday is a Dermatologist practicing at the Winnipeg clinic and is an Associate Professor with the Faculty of Medicine, University of Manitoba. He has trained at the University of Manitoba for both his MD and BSc Med and has additionally trained in New York with specialization of a Diplomate of the American Board of Dermatology (DAB Derm) University Skin and Cancer 1980 and an FRCP at the University of Manitoba 1983
He will discuss Dermatological problems in Travelers and will include emphasis on skin cancers in travellers, tropical illnesses in travelers and fungal infections. He has lectured on this for our group in the past and will include updates on the new powerful immunolgic drugs that are now being used routinely to treat skin cancers. This aspect of medicine is still one of the most important and exciting topics for clinicians- to learn about a non-toxic effective treatment for some severe cancers. This topic gives hope to very ill people and has been enthusiastically received at a number of sessions by both clinicians and non-clinicians alike.
Dr Terry Galloway is an Entomologist at the University of the Medicine. He has lectured to us several times and has always both entertained and informed us with accounts of the life of Insects. This year his talk will focus on Mosquitoes and he will also discuss the role mosquitoes played in the development of Malaria in the Dominican Republic this past winter.
Dr Elsa Hui-Derksen is a practicing Dentist with the Cholakis Dental group. She will present “Dental Emergencies in the Wilderness” as well as help define important components of a dental emergency kit. Her colleague Dr Eric Parsons will also present his recent dental relief work in Haiti.
Dr Scott Clifford, Veterinarian was tentatively scheduled to speak on the Avian Flu, continuing his previous years lecture on Zoonoses. He had defined emerging zoonoses as more likely with the increased communication among previously isolated biovars that had increased speciation in the past. As these isolated plants, animals, bacteria and viruses were brought together new recognized human diseases emerge as zoonoses through chance jump to humans. Scott is unable to join us because of work commitments but we wish him the best. Dr Podolsky will talk on Avian Flu in relation to the common cold and other flus and will add recent updates from the Public Health Agency of Canada that were recently presented here in Winnipeg at the National Antiviral Meeting.
Our Volunteers
We have volunteers from both our local Nursing and Medical Schools that will be attending the conference. We believe that it is important to include them as part of our forum as they will have fresh perspectives on a variety of topics and have much to contribute.
Delegates to our previous meeting might notice that some of the speakers this year were previously in the audience. We are always looking for new topics and new presenters and plan to rotate topics. We have done kept some lectures the same because there wide popularity but we plan on changing these as well.
Special Thanks to Candace Corroll, Gail Oborne and Kyoung-Hee Lee for their help in organizing this conference.
Feedback
Please fill in the feedback questionnaires and remember to take your certificate of attendance. This meeting is eligible for up to eleven M2 medical credit hours for physician and 10.75 CEUs for pharmacists. Pharmacists may also receive special accreditation cards on request.
We have tried to improve our meeting based on past feedback. This year we are having more formal meal breaks with a formal dinner and lunch set aside for our delegates to decompress.
We will be providing our volunteers with question sheets so that anyone who wishes to ask a question. If in our question period we are unable to answer all questions we will have our faulty respond later.
We are in the process of arranging two additional conferences that will expand on some of our present ideas.
European Neurology Conference in Odessa, Ukraine April 20th,2004.. Dr Podolsky will be attending and intends to bring some donations of medications that he will personally deliver to registered medical organizations there. He has asked for any clinicians who have any medications or useful medical equipment to please contact him. He is unable to accept cash only medications.
Arctic Medicine conference Oct 6,7,8,and 9 will take place on Thanksgiving weekend in Churchill Manitoba. This will involve 16 hrs of CME in the evenings. We have negotiated a group rate for accommodations that will also include a Tundra Buggy (Polar Bear Safari), Cultural program and a tour of Churchill- the Polar bear capital of the world. Delegates do not have to participate in any of the extra conference activities in order to attend our scientific meeting as our meeting is held separately and are welcome to stay at other accommodations.
Our keynote lecturer is Dr James Wilkerson one of the founder of the sub discipline of Wilderness Medicine. Those who register before September first will also receive a signed copy of his book “Medicine for Mountaineers”.
For those who cannot travel to Churchill a satellite symposium “Winter Sports Medicine” will be held in Winnipeg on October 5th, which will focus on more Sports medicine topics.
For more information on both please see the page at the back of this manual.
Advanced Wilderness Life Support is a new course that uses the ACLS and ATLS format. Dr Podolsky has recently been accredited as an instructor and may teach the course in Winnipeg. If interested please se him or one of our volunteers to go over the course.
Our Tropical medicine Meeting in Havana, Cuba is currently scheduled for February 2006. We are awaiting finalization with the Cuban government. This is planned to be a 36-credit conference with emphasis on Tropical Medicine and topics relevant to Cuba. We will be selecting our lecturers from Winnipeg and also plan on working with local Cuban physicians where Canadian and International people will be able to observe how the Cuban medical system works. Our goal is that by more direct interaction we may be able to help our colleagues financially and also learn valuable insights from their Medical system. We are still working on our program. Please see our volunteers for any questions and to be put on our mailing address update.
Women Traveller Scenarios
Candace Corroll
When women are travelling they may experience unique gender specific problems due to their physical differences from men and due to social forces.
The purpose of this session is to highlight common problems women may face and offer various solutions.
Abby is a 22 year woman going to Korea to teach English as a Second Language. She is going alone, although she has some contact phone numbers of people from her organization. She has never travelled before. She is physically healthy and has received all her immunizations but wants to know if there is anything else she should do before she leaves.
Abby has had a recent physical. She is sexually active but has not had a PAP test done recently. It is strongly recommended that she do so before she leaves. She is also taking the birth control pill and wishes to stay on it even though she will not have a current sexual partner. She was concerned about getting traveller’s diarrhea or taking other medication (such as antibiotics) that would affect the effectiveness of the pill. Her doctor discussed the new Birth control Patch (Evra) which is put on the skin for 3 weeks of the month and is not affected by nausea or stomach upset which can happen with travellers diarrhea.
Because she was going to be away for so long she was given information on how to find a doctor in Korea: www.istm.org (The International Society of Travel Medicine lists available clinics in many countries), www.iamat.com (International Association Medical Assistance to Travellers has a free list of Clinics that also agree to standardize their prices, www.voyage.gc.ca (gives a list of Canadian Embassies and Consuls that will not provide medical services but will give information).
Barbara is an 18-year-old mother of two twins age 8months. She is going to return to Ghana to visit her parents and show her children. Barbara wants to leave her 2 twins in Ghana for at least a year so she can finish her school. She wants them to receive all the immunizations they need including Yellow fever.
Barbara was informed of the various vaccinations related to travel to Ghana for her 3-week trip. Based on what she will be doing it was recommended that she receive Tetanus-diptheria, Polio, Typhoid, Hepatitis A and B; and Yellow fever along with mefloquine for malaria.
Her twins were healthy with 38-week gestation births now at 8 months of age with normal developmental milestones and no problems. They are under the care of a regular paediatrician. They are up to date on their regular childhood immunizations. It was recommended that they receive an early MMR vaccine (which does not actually count toward the recommended 12 month vaccination since circulating maternal antibodies may partially neutralize the MMR, yet this vaccine will cover them for their immediate trip.
Twinrix Junior was recommended and started. The hepatitis B component is specifically emphasized for children visiting Developing countries or long periods, as a great burden of Hepatitis B is acquired from innocent activities- such as roughhousing with other Hep B positive children in routine play, or living in a household with Hep B. The Hep A component is normally recommended for children over 12 months but in this instant these children would be living long term in Ghana and not be breast fed so the doctor recommended this to them off label. They were too young for the typhoid vaccine or the multivalent (menomune) meningitis vaccine.
Yellow fever is prohibited in children less than 9 months because of the risk of encephalitis yet these children would be at high risk of yellow fever in Ghana. Barbara was offered the choice of waiting for them to be a few months older and receiving it in Ghana versus receiving it just after their turning 9 months in Canada. She chose the latter.