What is a Travel Clinic?

• A Travel Clinic provides up to date, accurate information of the health and safety aspects of specific destinations, to travelers.
• By applying specific interventions, it ensures that the traveler remains healthy during his travels and returns home healthy.

Type of Travel Clinic

• Dedicated travel clinic
• Part of GP practice
• Pharmacy provided there is medical supervision by a travel medicine qualified doctor
• Integrated immunisation service
• Occupational health clinic i.e corporate health

Type of Service

• Pre travel screening and advisory service only
• Pre, intra- and post travel screening, treatment & advisory service

Staffing structure

Depending on the nature of the clinic & service provided:
• Doctor only
• Sister run under travel medicine doctor supervision
• Pharmacist run under travel medicine doctor supervision
• Dedicated receptionist
• Bookeeper
• Cleaner

Premises

• Is there a need in the area?
• Yellow fever licenses are granted in areas of need only
• one or two consulting rooms depending on usage & need of the area
• Reception area may be shared by other health care professionals
• Kitchen area is important & vaccine fridge may not be used for milk
• Visible to the public, passing trade & for referrals & appointments
• Easily accessible e.g. parking available

Yellow Fever License Requirements

• A licence can only be obtained from the Department Of Health (DoH) & is issued in accordance with the International Health Regulations Act No 28 of 1974
• Enroll for the Travel Medicine Course or any other recognised Travel Medicine qualification
• Enroll for a dispensing course to dispense malaria medication and treatment
• Apply for Section 38A for nursing staff through the DoH.

Equipment - general

• Telephone with extensions
• Credit card machine
• Desks and chairs
• Filing cabinet
• Examination couch
• Computer (INTERNET ACCESS IS ESSENTIAL)
• Fridge with freezer
• Fridge thermometer

Emergency Equipment

• Portable oxygen
• Ambu bag and airways
• Emergency drugs
- Adrenaline 1:1000 ampoules - Solu-cortef vials - Phenegan ampoules
• I.V .equipment
• Accessible emergency numbers

Health , Safety and Environment

• Work area well ventilated, clean and neat
• Medical waste disposed of according to protocols & standards
• Protocols for staff developed i.e needle stick injury
• Legal requirements fulfilled in terms of Occupational Health & Safety Act.

Supplies

• Vaccines
• Medicines
• Pill containers (if dispensing)
• Syringes &needles
• Swabs
• Sharps containers
• Travel kits
• Repellents containing DEET
• Nets etc.
• Stationery
• Vaccination cards
• Patient medical & travel forms
• Patient information leaflets & teaching aids.

Suppliers

• Reputable and reliable
• Correct transportation and storage - cold chain
• Prompt delivery
• Credit facilities
• Continuation of supply
• Notification of shortages

Storage of Medicines/Vaccines

• Medicines in cool, dry place under lock
• Pill counter
• Printed containers/pill packets
• All package inserts available
• Vaccines refrigerated (2-8 degrees)
• Temperature measured and recorded daily
• Stored in centre of fridge (not doors)
• Rotate stock regularly placing short dated stock in front
• Record batch number and expiry dates

Training

• Counselling techniques
• Emergency procedures
• Telephone answering techniques & triage
• Basic IT including Word & Excel
• Regular medical & travel medicine updates

Counselling

• Patient to complete comprehensive form including destination, length of travel and a full medical history.
• Utilise a dedicated data base with listed health risks worldwide or access to WHO/CDC websites.
• Staff trained in consulting & counselling procedures
• Maps / Atlas used to indicate areas of high risk & ensure staff & patients familiar with areas visited
• Product knowledge including indications, contra-indications & adverse reactions
• Information brochures used as detail aids

Administering Vaccines

• Ensure protocols & procedures available for staff regarding all vaccines
• Explain procedure to patient
• Awareness of fear
• Patient to sit or lie as vaso-vagal reaction may occur often as a result of fear
• Observe patient 20-30 minutes
• Ensure correct route is used as efficacy of vaccine may be compromised

Accounting

• Computerised accounting system
• Include Nappi codes/ICD10 codes for medical aid claims on the statement
• Decide between cash only or accounts/medical aid
• Stock control done regularly to minimize stock loss

Patient Records

• Must be retained for 10yrs (travel), 40 yrs (occupational health)
• Accurate recording by staff, particularly phone calls
• Accessible to staff but kept in lockable cabinet
Confidential
• Name, age, destination and full medical history
• Vaccines dispensed and batch numbers
• Medication given with dosage and quantity
• Adverse reactions clearly recorded
• All follow up calls noted

Vaccination Cards

• International Certificate of Vaccination Cards must be used for all Yellow Fever vaccinations.
• For other vaccinations various other cards issued by pharmaceutical companies or your own designed card may be used.

International Certificate of Vaccination (Yellow Card)

• Supplied by sanofi pasteur in accordance with the DoH. These cards are barcoded with a watermark
• WHO format adhered to
• Correctly completed in full including the following:
-Patients full name -Date of birth in full, sex -Patients signature -Date of admin written in full -Signature & designation -Manufacturer & Batch No. -Official stamp
• Only issue after yellow fever vaccine given
• Only issue a card if you have administered the vaccine
• Advise traveler to travel with the yellow card (certificate)

Other services

• Pre and post travel medical assessment
• Post travel medical assistance e.g. malaria screening
• Travel related products e.g travel wallets
• Travel insurance
• Telephonic travel helpline

Membership

• Join SASTM so that you have regular information on disease outbreaks, maintaining competence and up to date information on what is happening in the travel medicine world