… Prepared by TMA Clayton, Vic: Dr Craig Blandy,
Travel Risk has a Social Denominator
The university traveller travels to a university in another country for their studies or work. Over 2 million people travel for this purpose each year. The Australian Government Outbound Mobility Study (2008) states that there are 400,000 inbound people living in Australia on student or educational work visas and around 30,000 outbound. Most of these people link their academic and travel ambitions into a cultural experience. Australian universities are vibrant and culturally diverse communities that have evolved over the past decade as major contributors to world education.
Monash University operates a University Health Service for all students and staff. The Clayton campus has a population of nearly 20,000 with student enrolments and staff from nearly every country. These world people allow us, at the health service, the privilege to be the virtual traveller, enriching our travel experiences with their stories of home. It also allows us an insight into the influence of normal social customs and cultural exchange as risk factors in travel.
The desires and the risks of travel appear to have common denominators that are based in the learned social existence of the country of residence. Overall infectious disease is not the major risk to the health and wellbeing of travellers. The risks are embedded in the normal social behaviours of the landed destination abutted with those of the visitor. Those things that are known to the resident and are unknown to the visitor; or even those things experienced by the resident and not by the visitor.
There is a consistent message of understanding the nuances of the society; its rhythm. Most of the health risks of each group can be categorised in the same way; whether the person be here or there.
Preparation for Travel
Most inbound university travellers spend months studying the local nuances of life in Australia prior to arrival and are not easily misled by the early teasing of fellow students with stories of “drop bears” and “street kangaroos”. There is an American-Australian slang dictionary that is usually well studied to minimise social embarrassment such as the oft quoted example of the young man introducing himself to a young woman with “Hi … I’m Randy (Randolph)”.
Monash students travelling to overseas campuses of Monash University and overseas universities receive orientations to achieve a destination and cultural familiarisation.
First Principle: Understand the rhythm of the destination
Medications and Drugs
Australian customs law allows a person to bring with them up to 3 months of medication with evidence of its proper prescription in the country of residence. Many North American students are prescribed various medications for a range of mental health issues. Some of these medications are illegal in Australia. Australian customs law permits these students to carry with them a 3 month supply and then an Australian doctor needs to be consulted to gain special access to the medication. Each year there are students visited by efficient Australian customs officers following attempts to import medications, legally prescribed in another country, that range from marijuana to amphetamine derivatives. All travellers need to be aware of local laws; in this case ours.
For the outbound Australian it is illegal to take pharmaceutical benefit medications from Australia other than for personal use. Read more here.
A common request made to doctors is a letter listing the persons prescribed medications. This letter needs to describe the medication, form, strength and quantity needed. At the University Health Service we seek consent to declare the reason for use of the medication on the letter. Despite this letter, and the legitimate prescription of your medication in Australia you may still find yourself in close confrontation with foreign customs or police, just like some of our inbound students. In Greece it is illegal to transport codeine in any form, regardless of its clinical indication, and Singapore’s prohibition on chewing gum extends to Nicorette. So contact the embassy of the country you are visiting to ensure the medicine is legal in their jurisdiction. It is a good idea to carry medication in the original packaging to minimise confusion.
Second Principle: Understand the customs and laws
The major health risk to all travellers is road related injuries. The dangers of road and pedestrian travel have been addressed in the TMA Newsletter of August 2010; road travel in Vietnam. In Vietnam the traffic does not stop, like a school of fish it parts and goes around objects and those who have socially adapted responses to these patterns see it as organised, functional and in continuous flow. If you live there it has a predictable mass movement. In Bangkok it is more likely that mass movement is a complete stop, but it is consistent.
The student from Asia is not used to the pulse regulated movement of Australian city roads. It has a different rhythm; known to the resident and not to the visitor. It appears chaotic here with vehicles travelling at different speeds, in different lanes, changing lanes, and with incoherence in movement. How can a pedestrian find a path through a flow of traffic that has no tune? Why is a car required to stop just after just getting to speed? Given the predictability of the stop it makes little sense to get there quicker.
Many of the return travel consultations seen at the university health service involve accidents that occurred overseas; half of these relate to transport; roads, scooters, bikes and even walking. The risk that leads to the accident is often the lack of understanding of the rhythm of the road. In the main cities of Eastern Europe a pedestrian crossing offers the right to cross the road when it is clear; not a right to cross the road.
In the Baltic States it is a legal requirement for pedestrians to display reflectors, although this relies on vehicles having lights. Transgressors of either law face the same penalty and that penalty is increased by a factor of ten if either is under the influence of alcohol. The Nordic countries also advise reflectors.
Third Principle: Understand the Road
Many visiting students cannot swim or do not know of the real dangers of the Australian seaside. They have a fear of Australian sharks and for this reason spend most of their time in the shallows, the rock pools or at the water’s edge. Some students have been injured peering into “blow holes” or experienced intensive medical care after collecting the blue-ringed octopus fascinated by its capacity for glowing blue rings. These are risks known to the resident and unknown to the visitor.
Outbound students have been known to organise travel plans around holiday destinations and walking on the beach can provide different risks; known to the resident and unknown to the visitor.
Chigoe “Jigger” Flea
The jigger flea is found in tropical and sub-tropical climates, particularly in many parts of Latin America, the Caribbean, and sub-Saharan Africa. In Brazil, it can be found both in northern and southern regions. At 1mm it is not seen by human eyes. It burrows into the skin for blood meal whilst incubating the offspring and swells to become a blister or even a callous. These nearly always become infected.
At the edge of the beach, where the city merges with the sand are found the products of city life. Immersed in the sand the hookworm may be waiting to complete its life cycle in the human. They are more common and more frequent in warm destinations where feral animals roam and barefoot walking is hazardous from more than the hookworm. There was a recent outbreak on a Miami beach traced to feral cats.
Fourth Principle: Understand places of recreation
Our health service has the curious role of giving travel advice to world travellers on completion of their studies. Some have been away from home for five years and started a family. Natural immunity to exotic diseases such as malaria, typhoid and hepatitis A is diminished and their children have started life in a community relatively free of infectious diseases. Everyone needs their vaccinations updated including the vaccines they did not receive as children in their home country. There is also the risk that the rhythm of home may be forgotten.
Our university outbound travellers eventually become inbound. Most of their presentations relate to the following principle:
The Rhythm of Travel
Communities follow a socially constructed way of life; a rhythm. To reduce your travel risk at your destination learn the rhythm of the community and apply this to the road, the beach, the food and the law.