Longer Stay Travellers and Expatriates
The term expatriate refers to people who take up residence in another country for occupational reasons, returning to their original country when their business is completed. Longer stay travellers refers to those travelling for 6 months or more.
Prior to departure all longer term travellers should undergo thorough medical and dental examinations to identify underlying disease. This is particularly important if travelling to areas where medical and dental care is not readily available. In some countries poor quality and counterfeit medicines are used. It is important to ensure that appropriate travel health insurance is arranged.
Preparedness in advance and learning about the culture and language can greatly enhance the experience. The following general health advice may be useful:
More vaccines may be advised for the longer stay traveller and as vaccines take time to become effective, ideally advice should be sought about 6-8 weeks prior to departure.
- For countries where tetanus, polio and diphtheria are present, ensuring these are up to date is important.
- There is a risk of tuberculosis (TB) in unvaccinated individuals visiting countries with a high incidence of TB and mixing with the local population. Vaccine is only recommended for those under 16 years residing in a risk area for more than 3 months.
- Hepatitis A and typhoid vaccines are routinely advised for countries where cleanliness of food and water supplies is questionable.
- Meningococcal type ACW135Y infection is a risk for those visiting sub-Saharan Africa and mixing closely with the local population.
- Hepatitis B vaccine is useful for longer stay travellers in higher risk areas and for those at risk through occupation or lifestyle.
- Japanese encephalitis is recommended for longer stays in endemic regions.
- Yellow fever is recommended for endemic countries in Africa and South America and a yellow fever vaccination certificate may be necessary for crossing borders.
- Rabies vaccination is important for those who will not have access to or be remote from good medical facilities. Rabies vaccine is particularly advised for children who may be more inclined to approach animals.
The same main principles of malaria prevention apply to longer term travellers and expatriates as for the short term visitor. However, it is known that the risk of malaria increases with the length of stay while adherence to preventive measures decreases. The risks for longer term travellers varies depending on multiple factors including reason for travel, whether staying in rural or urban areas and access to medical facilities. There may be a reluctance to continue with antimalarial chemoprophylaxis and compliance can become poor. While it may be appropriate for certain travellers to stop taking chemoprophylaxis altogether (e.g. the expatriate who has access to medical facilities), this approach is not suitable for all longer stay travellers (e.g. backpackers with uncertain access to medical facilities). Specialist advice should be sought to allow full discussion around this subject. It is important for individuals to know that if chemoprophylaxis is stopped, there is a real risk of contracting malaria. Malaria prophylaxis is very important for children and during pregnancy and chemoprophylaxis should be used.
- Further information about the prevention of malaria.
Psychological and Cultural Issues
The term culture shock is used to describe the early process of cultural adaptation and symptoms include:
- Excessive concern about hygiene, food, drinking etc.
- Fear of physical contact with nationals.
- Fear around personal safety and security.
- Anger and frustration around the new country.
- A terrible longing to go home.
Difficulties with cultural adaptation can be exacerbated by:
- Separation from family and friends.
- Time differences between continents which deter maintaining contact with friends and relatives.
- Problems adjusting to a different climate.
- Unusual food.
- Changes in living standards and different social amenities.
- Language differences and difficulties.
- Religious differences.
- Coming to terms with difficult societal differences such as overt poverty and begging.
The screening of individuals for protracted visits overseas may be undertaken e.g. by employers or voluntary organisations to determine the suitability of an employee or volunteer to undertake an assignment.
Being open to new and different cultures and being patient, rather than critical, will help the traveller adapt to new and challenging adventures.
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