Make sure the only bug you catch is the travel bug!

By Aiden Jewelle Gonzales

It’s 2022, and there’s another bug going round – the travel bug. Borders are cautiously opening, Test & Go has been reinstated, and over two years of pent-up cabin fever is manifesting in a desire to explore the world. But before we can visit any of the viral destinations on our feed, we need to make sure we ourselves don’t go viral – or bacterial, or any of the many illnesses we can inadvertently catch when we’re somewhere new.

To allay our fears, Dr. Ramanpal Singh Thakral, a Travel Medicine and Tropical Disease Physician, Medical Director of International Medical Services, and the Head of Travel Medicine Service at Bangkok Hospital, spoke to Masala about the ways that we can prevent and treat disease before, during, and after travel. “Travel Medicine is about looking after people who travel,” he tells me. “We see people before travel to discuss ways in which diseases can be prevented, people who are currently travelling and have fallen ill, and people post travel who have returned back but continue to have problems.”

Born and raised in Bangkok, Dr. Raman went to Ruamrudee International School (RIS) before completing his Bachelor’s degree in Biochemistry at Georgetown University in the U.S. and medical degree at the University of Sydney in Australia, so he was well familiar with both the joys and fears of travelling. As for why he chose medicine and travel medicine in particular, he recalled how his “intention of becoming a doctor wasn’t solidified until [he] worked as a volunteer Emergency Medical Technician (EMT) at the university in the U.S.” After liking what he saw, and after completing his one-year internship in Australia and completing his Thai medical license exams, he enrolled in a tropical medicine course, which has shaped his career since.

“I enjoyed it, made friends from all over the world, and also had a chance to learn about the medical system here, particularly in the provinces,” he explains. “I then started work at Bangkok Hospital, where they were interested in starting a travel medicine unit, and they approached me to help start it, an opportunity that I accepted. During that process, I completed further training specifically in travel medicine from the College of Physicians and Surgeons, Glasgow.” He draws on his wealth of knowledge and experience to give us further insight into this field.

Tell us a little more about your specialisation – what exactly does it entail?

Before travelling, we discuss with people things like vaccinations; preventative medications for diseases such as malaria; and medications for self-treatment of potential issues like traveller’s diarrhoea. The discussion will also cover the range of diseases that the person can encounter, be it food borne, air borne, vector borne, animal borne, or soil borne.

Furthermore, if the traveller has chronic medical conditions that need to be followed up, we will also try to link them up with clinics overseas that are part of the International Society of Travel Medicine network.

For those who are currently travelling, and are ill, we will try to use our knowledge about the places they have travelled to, to expand the diagnostic spectrum and make the right diagnosis. Lastly, for those who have come back from their travels with a disease, knowledge about the disease spectrum at the country of travel aids in making the correct approach, and ultimately, the correct diagnosis.

With the increase in globalisation over the last few decades, travellers are increasingly exposed to different environments than they are used to. Can you walk us through the risks associated with frequent travel, as well as the general advice you would give to help mitigate these risks?

This would depend on the place of travel, the purpose of travel, and the sort of activities planned. For instance, a backpacker going to India for one month would be exposed to a wider spectrum of disease as compared with the businessman going on a short trip. Our vaccination advice (including medications for prevention and self-treatment) would then reflect this.

When travelling, what are some of the most common diseases/infections that people encounter, and how do they prevent it? For example, which vaccinations should people absolutely have before travelling, and which medications should we carry with us?

For instance, for travel in this region, the concerns for vaccine-preventable diseases are as follows:

• Hepatitis A – food borne
• Hepatitis B – blood borne, or by sexual contact
• Japanese Encephalitis – mosquito borne
• Rabies – animal borne
• Typhoid – food borne

There is no set of vaccines that one must absolutely take before travel, because this will depend on the destination, the traveller, and the purpose of travel. This is why consultation is so important. In terms of medications, I will recommend common over-the-counter medicines like paracetamol, ibuprofen, antihistamines, and antacids in addition to your regular medication. Make sure to always get a doctor’s certificate to go along with all prescribed medication!

What are some common healthcare misconceptions that you’d like to address, especially with regards to travel medicine?

In this day and age of free flow information, a lot of either unsubstantiated or flagrantly false information is being disseminated. I think people need to think carefully about what information they are processing and where it’s coming from. People need to see the value of evidence in medicine and the scientific process on the whole. The media also has to do their job and make sure that they don’t themselves propagate falsehoods.

With the advent of the pandemic, travel has been limited for the last two years, and even now, concerns about the Omicron variant (or future variants) remain. Can you weigh in on how we can keep as safe as we can while travelling at this time, and how you foresee the future of travel will change?

In my opinion, don’t travel unless you have to for now, at least until the pandemic subsides. I think once the pandemic subsides, travel will quickly resume, but it will take a while before we get to pre-COVID levels.