Practice healthy business travel. SUN CHRONICLE: July 3, 2000

BY BETSY SHEA-TAYLOR / SUN CHRONICLE STAFF

Dr. Daniel Carlin, MD, founder of WorldClinic, a private medical company in partnership for the past two years with Lahey Clinic in Burlington, went through it as a traveler years ago in a foreign country.

His dysentery was misdiagnosed as emergency appendicitis. Now he is helping corporate travelers avoid that kind of snafu with creation of WorldClinic, a pipeline to sophisticated medical accessibility. Advice, intervention and evacuation are a phone call away.

WorldClinic is one of a number of services that are cropping up as a crush of travel often to less developed destinations by an aging population adds up to a greater need for planning and vigilance.

Carlin's experience spans some of the world's most remote areas, including Southern Sudan, Haiti and Afghan refugee camps of northwest Pakistan. In 1995 he established Voyager Medicine, a medical practice for ocean sailors and remote expeditions. He made headlines two years ago as the `` Internet doctor'' who assisted, via e-mail, a solo Russian sailor to successfully perform life saving surgery on his own arm. He once e-mailed a diagram of the human ear and tricky treatment instructions to a sailor whose co-captain was suffering a bacterial infection. These clients were accustomed to high adventure. But corporate travelers -- especially novices -- are sometimes na'efve about the safety of foreign travel, most notably the resources they'll find in other countries.

`` They think there will be American quality care and immediate access to America quality care,'' said Carlin. `` It suddenly dawns on them traveling through Bolivia that they have driven 700 miles and not seen a single medical facility.''

As the world grows smaller, personal adventures and professional alliances are circling the globe. But so is concern for wellness.

Texas Instruments in Attleboro is an example of this mix of opportunity and caution. It is one of the nation's corporations with links to emergency travel firms which can provide anything from evacuation to lost prescription refills.

`` We have a lot of people who go to Mexico,'' said Verda Larsson, TI occupational health nurse. `` If you were going you would call us and set up an appointment to talk about what you need to have done. The pre-trip evaluation would be done here.''

Once out of the country, however, it is another distance medicine plan, AEA International, which is the first responder for TI travelers, said Larsson. Employees call directly for guidance in an emergency.

More than 80 percent of international business travelers surveyed recently by an independent research firm, Leflein Associates Inc., expressed concern about health while traveling on business to so-called emerging markets even though many took measures to help prevent problems.

Fifty-eight percent said they drank purified water, 47 percent maintained an exercise program, 41 percent took vitamins and supplements, 40 percent maintained the diet they have at home and 34 percent received immunizations before leaving. Their concern about potential problems is justified.

Twenty-nine percent reported that either they or a business associate had become ill or was injured while traveling overseas, yet many were still uncertain how to get help. After notifying family, more than one third said they would next contact a boss. But an emergency calls for emergency help.

`` Say you get sick and are in a hotel in Pakistan,'' said Carlin. `` You might call the concierge and ask for a doctor or hospital. But you don't speak Urdu and you don't know the doctor's qualifications. This invites miscommunication and misdiagnosis.

`` In that hotel room in Pakistan I don't know what will happen,'' said Carlin, adding, `` I was that person once.'' Several trends are creating urgent need for traveler medical backup. They include age, sheer numbers and shifting destinations.

`` There is the aging of our planet,'' said Carlin. `` The whole world is getting older and you have more senior Americans traveling.''

This is true of the corporate world and the retirement set in search of adventure. This is why WorldClinic suggests a stress test if there is a question of pre-existing heart disease, and treatment such as an angioplasty or stent placement if problems are discovered.

`` You can't have any areas of unaddressed risk,'' said Carlin. Even so, crisis can develop. Early this year, a 61-year-old chemical engineer from Andover who suffered a heart attack in his hotel room in Beijing, was guided to life-saving treatment after a phone call to Carlin.

Other anecdotes are legion:

An international engineering company senior executive developed a serious sinus problem at the start of a major business trip across five countries in Southeast Asia. WorldClinic provided long distance care and monitored him en route. Proper treatment enabled him to recover and keep working without interruption in schedule or loss of productivity. A professional vacationing in Portugal developed signs and symptoms of a painful yeast infection. Through an exchange of e-mails, the company had her take certain medicine in her Medical Kit. Then she was directed to a local pharmacy for a prescription refill. Within 48 hours, she completely recovered.

A worker in West Africa suffered severe second-degree flashburns. His company wanted to fly him back to the United States. WorldClinic knew this could endanger his life and intervened. The client was transferred to a pre-certified local hospital. Two days later, when stable, he was flown to a leading burn center in Ireland. Prior to arrival, WorldClinic consulted with the Center's doctors, and gave them the patient's status. The client made a full recovery, with no long-term complications.

A spider bit an expatriate. A local doctor said it wasn't serious. But three days later, symptoms developed. Concerned, he contacted WorldClinic who had him e-mail a photo taken with an inexpensive digital camera. The photo revealed a dangerous and rapidly evolving infection. An antibiotic was prescribed out of the client's personalized medical kit. Corporate travel is expected to increase by 30 percent next year, said Carlin.

Last year, 24 million Americans engaged in international travel. Fifty-six percent of business travel is outside western Europe, where medical treatment tends to be most advanced. Instead, this populace is heading to new markets such as Thailand, South America and some parts of Africa.

`` Take some time to plan, to read about where you're going and the kind of precautions you need to take,'' said Carlin. `` And you never want to be a in a vehicle at night, driving in a developing country.''

Texas Instruments in Attleboro has had a travel preparation program for several years. Last year TI linked with Sturdy Memorial Hospital in working with travelers, many of whom head to the company's facility in Aguascalientes, a city of nearly a half-million in the geographic center of Mexico. Verda Larsson explains the process.

A traveler undergoes a health risk assessment, is coached on health risks, which can change with season and even political climate, receives free immunizations, guidance on injury and illness prevention, and a travel kit of basic nonprescription medications and first-aid supplies. Risks can range from accidents to spider bite or parasites. `` We stress the importance of coming to us early because several immunizations need days to become effective, particularly hepatitis,'' she said. Some travelers get tuberculosis testing before and after a trip, depending upon destination. TI's contract with AEA International provides an immediate resource for those who still run into trouble while out of the country.

Their first call is to AEA's SOS program, said Larsson, which offers 24-hour advice from doctors in facilities throughout the world.

`` We look at the country the person will be visiting and how long they will stay and the kind of travel,'' said Larsson. `` If someone is just going to the plant for two days and coming right back it would be different than if they were staying for a week and sightseeing.''