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    Tips for Traveling in Third World Nations

    American healthcare professionals can share their expertise with others in an unusual and challenging way through disaster relief, mission work, collaborative research, and agency assignments. International travel, in particular, can be both exciting and rewarding. U.S. providers who practice in third world countries have the potential to make a significant contribution to the improvement of patient care. In return, they gain professional satisfaction and a greater awareness of world health needs. Perhaps more importantly, they receive the ultimate gratification of having made a difference.

    Excitement, boldness, and flexibility are a must for traveling providers, especially when visiting third world countries. However, initial feelings of eagerness and adventure may soon compete with those of culture shock, isolation, and loneliness. By following tips I have learned through my travels and participation in healthcare exchanges, professionals can prepare for and adapt to a new environment more quickly and with greater ease.

    PRIOR TO DEPARTURE
    To begin with, contact the coordinator of an agency you would like to represent. Share your interest and inquire into possible assignments.

    Review potential areas by researching countries and cultures. Evaluate the pros and cons of travel for you personally and professionally.

    If you decide to go, make a commitment with the facilitating organization, set departure dates, and prepare for the adventure. Follow agency guidelines for the planned international experience.

    Obtain a passport and visa once the location and dates have been confirmed. Manage licensure issues when applicable.

    Determine the immunizations you will need by contacting the Centers for Disease Control and Prevention (www.cdc.gov). Once at the site, click on "Traveler's Health," type in the region in the drop box, and click on "go." Scroll down the pages to read about recommended immunizations, tips, and other subjects of interest.

    When scheduling your immunizations, remember to plan enough time for boosters if applicable. Your local public health department should be able to help you or at least provide a referral to a site specializing in overseas travel.

    Keep in mind, too, that telephone rates are usually much higher when contacting a U.S. phone number from overseas. Securing an international calling card prior to leaving the States will help to defray costs.

    PACKING
    Wise travelers always plan for the unexpected. Listed below are some items you may want to consider packing.

    A passport is essential for identification and for entering and exiting a country. In the unfortunate event that your passport is lost or stolen, having duplicate information readily available will save you a lot of time and trouble. Keep copies of your passport, visa application, and birth certificate at your fingertips - as well as two extra passport pictures.

    Earplugs may come in very handy, too. The deafening roar of a jet engine on a long flight might give you sensory overload. Plus, many countries have escalated noise levels that could overwhelm your auditory senses.

    Since finding a 24-hour corner pharmacy is highly unlikely in a third world nation, you may want to pack a few of your own essentials. In addition to bringing along extra toothbrushes, include such over-the-counter medications as ASAs, antibiotics, antihistamines, anti-diarrheals, laxatives, and antacids. In addition, a sleep aid might help you to adjust more quickly to time zone changes and jet lag. Of course, take enough prescription medications for the designated time away from home - and consider packing two refills of any critical drugs such as anti-diabetics and anti-hypertensives.

    Culture shock has the potential to affect all of your senses, including taste. Being able to relate to a familiar flavor may be the luxury of the day. Individually wrapped snacks, tuna/cracker combos, and candy are a few items to consider packing. Vending machines are rare, even in the Western hotels. If you pack beverages, double bagging them in Ziplocs will decrease the chances of leakage in transit.

    Due to water contamination, boiled water is readily available in the majority of facilities and hotels; therefore, hot tea is the preferred drink for locals. If you are a coffee drinker, you may want to take instant coffee and/or individual coffee bags.

    You also might like to pack several business cards containing your name and stateside contact information. Foreigners enjoy receiving items written in English and these are always well received by the hosting representatives.

    Similarly, if you have room in your luggage, include inexpensive items that you can distribute as token gifts. Pens, pencils, mugs, and T-shirts that contain English words or phrases go over well.

    Don't forget to pack a small calculator - this minor appliance can be a major convenience on shopping trips. With it, you may avoid the awkwardness of fumbling with cost and exchange rates in your head.

    Another essential item to pack: hand sanitizer lotion or wipes. These are especially useful if you are assigned to a primitive area or travel to one during your days off.

    Photos of your family, home, or car not only can help you connect with loved ones when you are lonesome, but also establish rapport with your new friends. Pictures of family gatherings during holidays are particularly interesting and can elicit many questions.

    Western hotels are comparable to those in America. Yet, very few countries utilize the same electrical outlet or current; therefore, be sure to bring along electrical adapters. Also, if you are lodging in a local hotel, you may need to provide your own towels and washcloths. Convenient and disposable, Handiwipes save you the trouble of packing a wet washcloth. Also, Clorox Wipes can add to your comfort level, providing a disinfecting touch up to areas such as the toilet, tub, and vanity.

    ONCE YOU HAVE ARRIVED
    When traveling abroad, keep in mind that many foreigners view Americans as being haughty and arrogant. To enhance new relationships, travelers should arrive with humble attitudes. While U.S. healthcare technology and skills are advanced in many ways, American providers have much to learn from professionals in third world nations who overcome obstacles through sheer human effort and creativity.

    Dress appropriately, and adapt to the rules of the culture. For example, in some countries, a sleeveless blouse and pants may be considered unacceptable attire for a woman.

    Although rates are usually higher in airports, it is still a good idea to make a money exchange prior to leaving the facility. Money for taxis, food, and lodging may be needed before you are able to get to a local bank or exchange office.

    Unless a local contact is picking you up at the airport, keep a written copy of the name and address of the hotel to give to the taxi driver. Having a business card or letterhead with the hotel or apartment's name on it is also considered a safe measure - at least until you have become conversant in the native language. Regardless of your level of communication with the locals, if the driver can read the address in his language, you will always get back to your dwellings more quickly.

    Another tip: Exercise extreme caution when eating food purchased from vendors, especially in countries where hepatitis A and other diseases are prevalent. Always remember to peel or thoroughly cook fruits and vegetables.

    In many countries, bottled or canned water and drinks are the only safe beverages to consume. Avoid using ice that is made locally - it may be contaminated. Even when using bottled water to brush your teeth, you still may be at risk for contamination - if you forget and place your brush under running water. Be sure to keep extra toothbrushes within easy reach for these sorts of emergencies. For more tips on "Safe Food and Water," visit the CDC website.

    THE GLOBAL VIEW
    An international exchange with healthcare professionals in other countries is one of the many ways American providers can share their expertise as well as excite their own sense of adventure. The experiences that I have had with nurses in other countries are some of the highlights of my career.

    Do you want to take the plunge and say yes to this challenge? If so, you'll no doubt find deep personal and professional satisfaction from helping to improve patient care in third world countries. And, like mine, your life will be changed forever.

    Reference
    Centers for Disease Control and Prevention. [Online]. Available www.cdc.gov, September 2001.

    For an expanded list of volunteer agencies and their contact information, visit the Resource Center on www.healthcaretraveler.com/resource/volunteer.cfm.

    Betty Jo Aguillard
    Betty Jo Aguillard, MSN, RN, is professor of nursing at Louisiana State University at Eunice, in Eunice, Louisiana. Participating in ...