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Travelling well

A Canadian nurse, trained in travel health, has built a career on specialist counselling about vaccines, avoiding tropical disease and illness.

In 2012, 8.2 million Australians left Australia for a short-term trip.

Ten years ago, this number was 3.5 million (ABS 2002). Many of these travellers are leaving without making adequate preparations.

With this increase in travel comes the desire for adventurous and remote locations, whether for pleasure or working holidays. Trips associated with work such as IT and factory developments are now occurring in countries that would have been considered ‘high risk’ years ago.

The mining industry is booming in southeast Asia and Africa, and Australians are relocating to these countries at short notice. Many people are also entering Australia as asylum seekers, and on humanitarian visas. All of these individuals need specialist counselling on appropriate vaccines, vector-borne diseases, tropical disease avoidance and discussions on specific signs and symptoms of potential illness to be on the lookout for upon return home, or while still abroad.

Travel health encompasses a broad number of needs such as migrant health, public health, occupational health, as well as wilderness and adventure sports such as altitude, diving and extreme sports. Nurses in Australia are an integral part of this specialty area.

Many of us involved are avid travellers and enthusiasts of diving, altitude hiking and working overseas. Nurses are very familiar with the needs of travellers and what pitfalls can occur medically while away.

Nurses have been involved in travel health in Australia since the 1990s.

With the rise of specialist nursing and nurse practitioners, this area of preventative medicine is an excellent area for nurses to be working autonomously and collaboratively with their medical peers.

Having a specialist nursing focus, nurses are able to provide services that include detailed health histories specific to each traveller, appropriate creation of treatment plans for all ages that include travel immunisations along with detailed teaching on numerous subjects specific to travel health.

The nurse’s ability to take complex information and teach it to clients at a level they can understand is one of the strengths of the profession.

Information on subjects such as leptosporosis, schistosomiasis and Japanese encephalitis for instance can leave the average travellers’ head in a spin, but these are important areas of information that many clients need defined and to know if they are in fact at risk. Handouts also have been created to follow up on the information given.

There are many specialist travel clinics across Australia. Umbrella groups such as Travel Medicine Alliance and Travel Medicine Vaccination Clinics have locations in every state.

Within these clinics are doctors and nurses working together to provide a holistic service to clients. Many of the clinics are doctor-led; however an increasing number of them are becoming focused on their specialist nursing staff.

It is imperative that a ‘cookie cutter’ approach is never taken for travellers, as their background of previous travel and immunisations, age, current health, travel itinerary and style of travel must be taken into account when considering the needs for these people and quite often either elderly or infant companions.

I come from Canada, and have worked in this industry since 2002 as a specialist nurse in travel health. In North America, travel services were provided by public health units or councils. With cutbacks in the 1980s, the Canadian government no longer funded travel-related vaccines or consultations, and it was up to individuals to seek advice on what they would need for their own protection.

Many doctors and nurses embarked on specialist training in travel health to ensure a high quality of service and counselling. I personally have undergone a high level of training, including a Certificate of Travel Health through the International Society of Travel Medicine (two years of consistent counselling to pass this exam), a Diploma of Travel Medicine through the Royal College of Physician and Surgeons Glasgow (a year of study at a Masters level in the UK), professional certificate of Immunisation through UniSA, and finally a Masters of Advanced Clinical Practice/ Nurse Practitioner from Flinders University.

I also attend numerous international conferences and on occasion share my specialist nursing knowledge. The specific travel medicine/ health courses are offered to nurses, pharmacists and doctors who are interested in this area of study. James Cook University in Australia offers similar courses. This exciting field is endless.

It has been a long road, but one that has allowed the clients coming into our clinic in South Australia to realise that I have appropriate, detailed specialist training and knowledge that allows them a high quality of care. Clients coming to the clinic are pleased to see a nurse with a scope of practice that they can access and obtain all their travel needs at one location.

Travellers’ needs are varied across age groups, stages of life and many have chronic diseases and want to travel or work in remote settings. Working collaboratively to ensure these travellers have thought of everything and have covered all their bases before travel with both the specialist nurse and referral back to their GP or medical specialist is quite often necessary.

Using nurses within either specialist clinics or general practice in this role will allow not only the clients to receive focused care, it frees up the doctors within their practices to deal with those who are ill, not those who are want to prevent illness while abroad.

Canada has embraced nurse practitioners and specialist nurses for years. Consumers have asked for changes in health care and for more convenient access to health care. This has led more professionals to seek specific knowledge and set up clinics specialising in travel medicine/ health or to have a dedicated practice nurse take over this important area within a general practice. Australia is slowly embracing this change.

A high level of specialist training and understanding by nurses about travel health must be maintained to ensure quality of service and understanding. An outline for a scope of practice for travel health nursing such as those used in Canada or the UK should be created.

With the increase of adventure travel, work overseas and more people coming from developing countries as asylum seekers or those on humanitarian visas, travel health as an area of specialty is growing, and with that is a need for specialist nursing within Australia.

Lani Ramsey works in Adelaide, South Australia at Travel-Bug Vaccination Clinic. She has been a nurse practitioner candidate since 2001, and is also vice-chair of the Nursing Practice Group within the ISTM.

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