INFORMATION TO DISCUSS WITH YOUR DOCTOR Frontier medical policy and malaria phrophylaxis advice Please present this document to your doctor when you are discussing malaria phrophylaxis for your project.
FRONTIER MEDICAL POLICY: Frontier s medical policy places a strong emphasis on prevention, as successful treatment of illness and injury cannot be taken for granted in a developing country or a remote tropical environment. Individual volunteers are encouraged to take proper responsibility for their health and each person is required to have a personal medical kit. In the event of illness or injury requiring treatment, advice is sought from an appropriate local doctor or medical facility. Prescription drugs such as antibiotics and antimicrobials are included in the highly recommended medical kit list in case a local doctor prescribes such a drug but does not actually have a supply available. This is a sensible precaution when travelling in developing countries. Frontier medical policy instructs project staff (who are not medically qualified themselves) to discourage volunteers from taking prescribed drugs in the absence of qualified medical advice. The projects medical policy is endorsed by the Consultant to the Travel Clinic at the London Hospital for Tropical Diseases, who also acts as Medical Adviser to Frontier. MALARIA PROPHYLAXIS ADVICE: The following advice is based on recommendations from the London Hospital for Tropical Diseases and the Communicable Disease and Public Health Report - Guidelines for the prevention of malaria in travellers from the United Kingdom (a report of the virtual consensus of the views of 44 doctors, nurses and pharmacists with special expertise in malariology or travel medicine) CDR Review, Volume 6, Review Number 3, 2003, pages 180-199. As you are aware your patient will be visiting a remote rural area of a developing country for an extended period. There may be a risk of contracting malaria. In Tanzania, for example, this risk is very high and chloroquine resistance is widespread, so much so its protective efficiency appears to have fallen to below 70%. Mefloquine is the current recommended chemoprophylaxis for Frontier personnel including SCUBA divers. Chloroquine remains recommended for Nicaragua, though not with proquanil. Mefloquine has received a lot of bad press in recent years however, we are advised that the protective benefits of mefloquine will usually outweigh the risks of adverse effects for visits exceeding 2 weeks to East Africa or South East Asia. Travellers are advised to start taking mefloquine 3 weeks before going abroad enabling them to have received three doses, with at least three subsequent days before departure. The drug will then have reached a protective level before the traveller arrives in a malarial area. Starting 3 weeks before departure also allows sufficient time for adverse effects to become manifest and if necessary a switch to alternative chemoprophylaxis. Most authorities believe that proguanil plus choloroquine gives inadequate protection to travellers who will spend a night or more on safari in a rural area and is not recommended for anyone staying in a malarious area for longer than 2 weeks. Alternative antimalarial chemoprophylaxis are Doxycycline and Malarone, which are only suitable for certain travellers who for medical reasons cannot use mefloquine. Doctors and practice nurses can also consult the following sources for advice on malaria prevention: Health Protection Agency: www.hpa.org.uk or 01980 612100 London Hospital for Tropical Diseases: www.thehtd.org or 0207 388 9600 PHLS Malaria Reference Laboratory: malaria-reference.co.uk or 020 7927 2437 Birmingham 0121 766 6611 Glasgow 0141 3001130 Liverpool 0151 708 9393 Oxford 01865 225 217 2007 Frontier
MEDICAL FORM Self Assessment Medical Details are dealt with in strict confidence Surname: Forename(s): To the Participant: The purpose of this medical questionnaire is to find out if you should be examined by your doctor before participating in one of our overseas projects or expeditions. A positive response to a question does not necessarily disqualify you from the project. A positive response means that there is a preexisting condition that may affect your safety during the trip abroad and you must seek the advice of a physician prior to travelling. Please answer truthfully as failure to disclose information may result in your repatriation from the project. Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, you must consult with a physician prior to participating in the expedition. This form MUST be signed by your doctor if you are participating in the Fiji Medical, Teaching or Sports Coaching projects. Could you be pregnant, or are you attempting to become pregnant? Are you presently taking prescription medications? (With the exception of birth control or anti-malarial) Are you over 45 years of age and can answer YES to one or more of the following? Currently smoke a pipe, cigars or cigarettes Have a high cholesterol level Have a family history of heart attacks or strokes Are currently receiving medical care High blood pressure Diabetes mellitus, even if controlled by diet alone Have you ever had or do you currently have Any serious/severe medical condition? Chronic/severe eczema? Chronic/severe asthma? Any allergies to anesthetic? Any allergies to particular drugs? Frequent or severe attacks of hayfever? Any allergies which require the immediate use of Epinephrine? Sinusitis or bronchitis? Any form of lung disease? Pneumothorax (collapsed lung)? Other chest disease or chest surgery? Behavioral health, mental psychological problems (e.g. but not limited to panic attacks, fear of closed or open spaces)? Epilepsy, seizures, convulsions or take medications to prevent them? Recurring complicated migraine headaches or take medications to prevent them?
Blackouts or fainting (full or partial loss of consciousness)? Frequent or severe suffering from motion sickness (seasick, car sick, etc.)? Dysentry or dehydration requiring medical intervention? Any dive accidents or decompression sickness? Inability to perform moderate exercise (example: walk 1.6km/one mile within 12 minutes)? Head injury with loss of consciousness in the past 5 years? A blood transfusion? An anesthetic (excluding use at the dentist)? Recurrent and severe back problems? Back or spinal surgery? Diabetes? Back, arm or leg problems following surgery, injury or fracture? High blood pressure or take medicine to control blood pressure? Heart disease? Heart attack? Angina, heart surgery or blood vessel surgery? Sinus surgery? Ear disease or surgery, hearing loss or problems with balance? Recurrent ear problems? Bleeding or other blood disorders? Hernia? Ulcers or ulcer surgery? A colostomy or ileostomy? Recreational drug use or treatment for, or alcoholism in the past 5 years? Please ensure that you consult with your medical practitioner about all the vaccinations required for travel to your project destination. Please ensure you consult your medical practitioner about which malaria prophylaxis (if any) is required for travel to your project destination. The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for any omissions or the failure to disclose any existing or past health condition. (Applicants under the age of 18 must have this form counter signed by a Parent or Guardian). Signature Signature of Parent or Guardian
Participant Please Print Legibly. Name of Birth Mailing City Country Home Phone First Initial Last DD/MM/YYYY Name and of Family Age Region Postal Code Business Phone Fax of last physical examination Name of examiner Phone This section must be completed if you answered YES to any of the questions above. Your patient will be participating in one of our overseas projects or expeditions, during which he or she will be subjected to various physical and mental stresses. If there is any matter concerning your patient with which you consider the project ought to be acquainted, whether now or in the event of a given situation during the project, it will be appreciated if you will please give details. Thank you for your cooperation s Impression I find no medical conditions that would adversely affect participation on the project I am unable to recommend this individual for participation on the project Remarks s signature or Legal representative of Medical Practitioner DDMMYYYY Phone Return this form to: Volunteer Co-ordinator, Frontier, 50-52 Rivington Street, London, EC2A 3QP