WHAT WILL I NEED?

A boundless supply of patience and enthusiasm, are a good start, but do not substitute for poor planning. Now is the time to get started and learn as much as possible about the area you hope to be going. You will be expected to comport yourselves as medical students, that is, professionals in training, primed to extract as much as possible from this experience and to contribute in turn what you can-which is somewhat less than your patients there will expect from you and something more than your reasonable anxieties predict you can do.

TRAVEL:
You will need documents: passport, visa (lucky you, you are in Washington now, within bicycling range of the world's embassies and consulates). These are also the sources of maps, brochures, information on bragging rights for their home countries, and often take extraordinary interest in you as a medical student going to do something in their nations. Use their proximity as part of your own process of getting pumped up for the trip, and something to keep you excited as you are sitting through another POM exercise!

It is helpful to carry with you your address book (remember the envious back at home who love to see postcards with exotic stamps!), emergency phone numbers, a birth certificate copy and a few documents pertaining to high value items you may have carried with you (a sales slip for your camera or laptop). Carry a list of email addresses with your PCMCIA card modem. And also know the emergency numbers of the US embassy, consulate, or USIS in the nation to which you are travelling. You also have this anchor line at GWUMC to which you can send an SOS.

WHAT DO I PACK?
Less. The old statement that you should take less clothes and more money does not apply to most medical students, and you really do not need much once there. I would advise that you carry a limited amount of US currency, only about half that amount in local currency (exchange at a bank after you arrive), and maybe four times that amount in US Traveler's Checks. Most of your big-ticket items can be floated on good old US plastic, and there are offices such as American Express in the arrival capital, often even the airport to "top up." This is not a luxury tour, and there should be pre-arranged housing commitments that will take on most of the need for other uses of currency; you should not plan to carry vast quantities of souvenirs out-film, notes and memories do just fine as higher "value added" commodities.

You will need a ticket to ride-see the section on "HOW ON EARTH DO I PAY FOR ALL THIS?" You need a sponsor who will supervise your work there and approval of a mentor here-and I will help you with that.

You need to be prepared to approach this as a "special project", one of many which you have carried out in your educational and medical school career in which you evaluate and data and come to an assessment of the experience in much the same way that you would the clinical assessment of a patient's story, and similarly generate a report detailing the process. You will have the opportunity to post the opinions and recounting of this experience in this web page site to help following students evaluate the potential for this site for them based on your experience. Throw in a few pictures! This is your chance to be the star of your own show in this senior project, the equivalent of other graduate students' thesis defense. You will NOT BE COMPLETED in this course nor awarded credit for it until your report is submitted.

HEALTH:
There are some special circumstances in various latitudes and environments that call for certain hygienic precautions and preventive measures. Many of these you are already aware of and relate to safety of drinking water, vaccinations and prophylaxis against the risk of certain contagion's depending on latitude, altitude and attitude. I can advise you with many of these matters from some local knowledge of the environments, and also from my capacity as tropical medicine graduate of the London School of Tropical Medicine and Hygiene, advisor to the Royal Geographical Society's Expeditionary Advisory Centre, member of both the Royal and the American Society of Tropical Medicine and Hygiene, and various traveler's health services.

In short, you should be up to date on the usual immunizations, such as the EPI (DPT plus polio, MMR, hepatitis). For some environments, I would recommend yellow fever (good for ten years and among the very best of any immunizations we have, so get one anyway even if you are not sure of the exposure at the area through which you are travelling), for still others, typhoid (TAB) inoculation. For fewer still, I would recommend selected individuals have gamma globulin in some regional exposures, and for very few at all do I suggest cholera inoculation (one of our least useful immunizations, and one in which the false sense of security should not detract from the real prophylaxis of careful treatment of water).

Now comes the special and perennial question of malaria prophylaxis-why, where, with what for how long. Yes, if you are going to or through an area of endemic malaria, you should be on prophylaxis, before, during and after exposure. With what depends on the length of exposure, the incidence of resistant plasmodia, and your own tolerance for some of the drugs. My rule of thumb is that for individuals who do not get significant side effects from the drug, Mefloquin (Lariam) would be the drug of choice in once a week dosing for those who will not be on it for more than six weeks to three months. You should remember not just where you will be working, but areas through which you will be passing, since often the holiday in the game reserve or down at the beach at the conclusion of your stay is a greater risk to your health, than working with diseased individuals at higher altitude and lower temperatures!

Special circumstances would be discussed with you before departure on the subjects of TB prophylaxis for some, for some Andean, Himalayan or alpine areas, acetazolamide (Diamox), but these advise patterns are individualized and not generalized. Very specific to you and your own needs are such things as a spare pair of prescription glasses, if needed, any medications that you take for your own (and cannot expect to find in the generic "chemist's" shop-at least by any name and familiar dose), and items that you may have been accustomed to thinking commodity items-eg, there are no tampons and few sanitary napkins available in some parts of a world that has somehow gotten along without them. Simple pain medications (eg aspirin, ibuprofen) are not always assumed elsewhere and if you are in the habit of taking a vitamin supplement, pack them along. These are toiletry items, however, and you know what you typically carry. I am excluding from this list precautionary packets of big gun antibiotics (now is not the time to experiment with your tolerance for an agent you have not had before); it is sensible to carry rehydration salt packets and an oral agent such as Bactrim and symptomatic Lomotil.

Most of your travel medical needs can be handled at the local travelers' clinic, and special needs can be discussed for unique personal or situational requirements.