Safety and Cultural Sensitivity When Working Abroad

1
Safety and Cultural Sensitivity When Working
Abroad

• Geoff Taylor
• Division of Infectious Diseases
• Acting Director Global Health
• University of Alberta

2
Safety in Clinical Settings

• Inpatient and outpatient units are typically very
  crowded
• Many patients will have Tb communicable GI
  pathogens or HIV
• Traditional hand washing facilities may be absent
• Hand hygiene may not be the cultural norm
• Strongly consider taking a supply of alcohol hand
  rub

3
Safety in Clinical Settings

• In Africa, 50-70 of inpatient medical unit
  patients may be HIV ()
• HBV, HCV are also common
• Do not do your first invasive procedures in these
  settings
• Wear gloves during procedures even if it is not
  the cultural norm
• Care with disposal of sharps
• In the event of exposure , you should strongly
  consider ARVs

4
Risk and Prevention of Blood Borne Pathogens in
Occupational Settings
5
Post Exposure Prophylaxis (PEP) following HIV
exposure

• May reduce relative risk of HIV transmission by
  up to 80 ( ie average needlestick risk from 0.3
  to lt0.1, absolute risk reduction 0.2)
• Defined exposure
• Probable HIV() source patient
• Definite exposure -blood or defined body
  fluid -percutaneous/mucous membrane/ non
  intact skin
• Immediate (the sooner the better, but up to 3
  days) initiation of combination antiretroviral
  therapy(2 or 3 drugs)
• Available in most urban settings. In remote
  settings availability less certain consider
  taking a starting supply.
• Combivir ( AZT lamivudine) bid X 4 wks
• Third drug protease inhibitor for very serious
  exposures
• DO NOT take nevirapine ( Viracept ) or
  nevirapine containing compounds ( eg Triommune)
  for PEP fatal hepatitis has occured

6
General Safety

• Traffic accidents are the most likely cause of
  serious injury or disability.
• Consider avoiding highway travel at night.
• Evaluate the safety of any form of conveyance
• Evacuation insurance is a good buy

7
Food and water safety

• Its not fun having a GI illness in a hot climate
  with poor health infrastructure and sketchy
  toilets
• Heated or peeled food only
• Bottled ( sealed ) or boiled liquids. No ice
  cubes.
• Hand hygiene

8
Vaccines and drugs

• Expert advice ! rather than casual opinions of
  friends/relatives or clinical mentors
• Antimalarials
• mefloquine
• Malarone
• doxycycline
• Mosquito netting (impregnated)
• Antimotility/antinausea drugs
• HAV
• Yellow fever
• Typhoid
• Consider rabies depending on location and duration

9
Medical and non-Medical Cultural Sensitivity

• Medical
• Remember, youre there to learn and you are an
  ambassador of yourself, your family , U of A and
  Canada (no pressure!)
• Never use the phrase Back home, we would
• As in back home we would do an MRI.

• Non-Medical
• Non-Western countries are usually more culturally
  conservative. When in Rome
• The status of women may be different (though
  medically , women often occupy senior positions).
  Western women may be the target of unwanted
  attention.