Considering our Troops Health Abroad

Many people have asked me about Afghanistan and the possible hazards our troops could face. Previously, I have worked as civilian physician for the Canadian air force and saw soldiers for pre and post deployment in prior operations. The military approach to travel medicine has some similarities to civilian travelers but much is also different.

In general, a civilian travel medicine assessment can be more complex than a military one since vacationers may plan a wider spectrum of activities and be subjected to varying risks, as a result, more individual counselling and discussion is required.

The Department of National Defence determines the requirements for their soldiers for each operation. In order to be ready for deployment individuals must be up to date on their medicals and immunizations. “Vaccine parade” clinics are held regularly since each operation requires specific vaccinations. Informed consent is still required from each military personnel prior to immunization, however if vaccination is declined, they cannot be deployed for that operation.

The immunizations that soldiers are required to have are usually the same ones that we recommend for travellers. Common vaccines that are recommended for long trips to Afghanistan (for civilians) include Hepatitis A and B, tetanus-diptheria-polio, and typhoid.

Given that deployments may cover different geographic conditions soldiers may receive more vaccinations then recommended to travelers simply because their exposure is different. Troops stationed overseas, unlike travelers, also have access to Canadian Doctors and medics. This helps with prevention and surveillance of problems. A wide spectrum of problems can be handled abroad whereas vacationers must either access local healthcare personnel or wait until returning home to see a doctor.

In Afghanistan there are various non- immunization hazards, for which proper protocols in prevention are maintained. Snakes and scorpions are more likely to be a problem outside of Kabul and Kandahar and are avoided through proper vigilance. Travelers when camping in scorpion endemic areas are reminded to carefully check their boots for unwanted scorpion tenants. Infantry are exposed to numerous insects more so than tourists. While most are nuisances, several insects are vectors of disease. The most important diseases that are spread by insects are Malaria and Leishmaniasis, which are transmitted by night biting mosquitoes and sand flies, respectively. Proper control for both types of illnesses can include wearing clothing to protect exposed skin, using permethrin (insecticide) on clothing and mosquito nets; and using DEET (insect repellent) on exposed skin. Additionally, anti-malaria medications can help to prevent malaria as well.

Military experience has shown it is much better to prevent illnesses through standardized protocols, which have been adopted for the purpose of civilian travel medicine. Even following all advice and taking the necessary precautions, illness can still occur. This is why all unusual symptoms must be reported to either a medic or physician, especially since there is often a latent period before the onset of symptoms.

One thing to remember is that both Malaria and Leishmaniasis, although severe diseases, are not transmitted in Canada. Returning travelers are not infectious to friends and family as both illnesses are acquired through insects not native to Canada, as a result there is no reason to quarantine or stigmatise these ill individuals.

Travel medicine owes a great debt to military medicine from both classical and modern experiences. It is important to acknowledge the contributions of our soldiers in the characterizations and treatments of many diseases.

Dr Podolsky previously worked at 17 Wing Squadron in Winnipeg and was also involved with recent potential use of the vaccinia (smallpox) vaccine. He presently works in private practice. He has worked with local flight surgeons, medics and military nurses and would like to acknowledge their contribution to this article.