Life in the hot spot
Anna Hardy reports on life in an NHS travel clinic
at university college london Hospitals we are fortunate enough to run a very successful service for patients and the medical world at large. Tourists returning from overseas adventures (good and bad ones) can get tested for malaria and receive results in one hour and see a doctor the same day. General Practitioners and hospital doctors throughout the country can get telephone advice from experts on all things tropical. Our parasitology lab excels in excellent quality and speed of service. We also run a fee paying travel clinic, which services not only tourists but also professionals on their way to overseas work with NGOs and TV reporters off to the hot spots of the globe.
It has been interesting for me, following several years of NGO work overseas, to see how different our clients expectations are and how our NHS systems often don't meet them.
I have been astonished at the number of patients who come with genuine complaints, not having managed to get an appointment with their GPs in the London area, some even finding it an obstacle course to get registered. Recent government surveys show most London GP practices are lagging behind the rest of the country in the target set to get patients access to a GP within 48 hours. In desperation and panic at the possibility of a tropical disease they know little about, they go to Accident and Emergency departments, wait too many hours, get a battery of blood tests, and without waiting for results, go to another one, and eventually to us, with no results on hand, some with semi-started or semi-abandoned treatments and a complete loss of faith. Some, tired of the "chase", ask for private treatment to speed things up.
Life in the fast lane also demands the instant service/cure. In the nurses triage room at the Emergency Walk-in clinic, the following episode is far from rare:"I have x/@zy wrong with me""I see" we should test you for this that or the other""Can you do it quick, my flight to the other side of the world is in four hours, I'll only be gone three months""
Which brings me to our Travel Clinic.One of the main functions here is to provide up-to-date information regarding malaria prophylaxis, necessary vaccinations and health preserving behaviours whilst in strange and often hazardous situations.
Our clients come from a wide spectrum of society and a multitude of countries; well-to-do, not so well off, very well educated to not so bright. This is a glimpse of the people we see:- Well seasoned travellers who know what they want.- First timers who would swallow arsenic if you told them to.- The internet investigators who come up with amazing alternative treatments none of the travel experts have ever heard of (does keep you on your toes).- The worried brigade that want every injection ever manufactured (look out for smallpox requests")- The "I've always taken this" people with whom you have to take forever to convince there is such a thing as "no longer effective, you will get Malaria if you rely on that".- The mums that bring not only their own children but a battery of other people's children all for their "jabs".- The man who wants to make sure his sons are vaccinated but is not bothered about the daughters.- The mad brave young professionals who are going to "do" Africa on a motorbike.- The heavily pregnant women who want to go off to the depths of some quite dangerous place with no medical facilities and want us to say they will be OK.- The confused ones who seek advice from every quarter and are going mad because everyone says something different.
Rapid assessment needed on entry with a psychological sensor is a good thing to have under such circumstances.
Part of our problem is that we are becoming so overloaded with information, our people cannot see the wood from the trees. Every day the media will report on some controversial medical advancement - this is good for you today, bad for you tomorrow. Research does not stand still and clever studies can directly contradict each other with each one presenting equally convincing arguments (for example, the MMR story).
We try to balance essential information with time constraints at our clinics, and wait expectantly for the next surprise just around the corner"
