Planning for Travel With Children in the Modern World.

ou are part of a busy group, primary care, practice in a mid-sized "college town" that serves an economically and culturally diverse patient population. Your first patients of the day are two siblings, a 3-year-old girl and a 9-month-old boy who present with upper respiratory tract symptoms and concern about possible otitis media. The parents, both of whom emigrated approximately 4 years ago to the United States, mention that the family is "traveling home to Cameroon" next week to spend 2 weeks visiting the childrens' grandparents. Standing in the doorway on the way, the mother asks you if the children "need any shots?" A week later, a family of four comes in to discuss that they are moving to Thailand for an estimated 3 years to follow the parents' newest positions in a large non-governmental organ- ization (NGO). They include a 47-year-old father with no health problems, a 49-year-old mother who is on chronic therapy for rheumatoid arthritis, and three healthy children with the ages of 9, 14, and 16. They will reside in Bangkok, but will be working on a rural development project in the north near the city of Chiang Mai, will likely visit displaced persons camps near the Thailand-Cambodia border, and plan to travel extensively as a family in the region. Later that day, one of your "routine physical exam" appointments is a healthy 17-year-old female high-school student, who is going to work for 8 weeks at a rural church mission site in the Amazon basin of Peru. She will help staff a program that provides early childhood education in a community of subsistence farming families. She antici- pates traveling with another friend, planning to use any free time to extensively explore the region through hiking and kayaking. Each patient or family is asking the same questions, in general. "What can we do to reduce our risk of becoming ill or injured during our stay in these foreign sites? What should we do to prepare for our trips? Do you have any advice we should follow during travel?" The family from Cameroon is not too concerned—after all, they are revisiting a country where they spent most of their lives, and have relatives who know their way around. They have however, not been back home in several years, and the health infrastructure of their country is limited. You are concerned about their "lack of concern" and casual attitude towards advanced preparation. The family moving with the NGO has already had a series of briefings and studied both written and web-based preparation materials. They are also receiving advice from a sponsoring family residing in their future county, arranged by their agency, to help orient them to the culture, challenges, and opportunities of living overseas. They will be residing in a large, rapidly developing country, with access to a modern health care system in most of the major population areas. They do plan to visit several remote sites, and are very proactive about their "planning." The young missionary is highly enthused and very motivated, but is working with a small group of volunteers working under a newer agency, and does not seem to have as much institutional support for travel preparation. While all three sets of travelers are focuses their concerns on preventing infectious diseases, you note that their planned activities will include several other potential travel risks; including motor vehicle and water-sport hazards, extreme environmental condi- tions, crime, potential government stability issues, and the simple challenges of the travel infrastructure.