Aid Workers, Expatriates and Travel.

Assignments range for less than 3 months to many years, and the risk of illness among expatriates is influenced by a variety of factors which affect other travellers including age, sex, behaviour, climate and the environment, infectious diseases and injuries. However, the complexity of cross-cultural assignments and the varied physical and emotional responses predisposes expatriates to medical problems that are not shared by the short-term traveller. These include increased morbidity and mortality, psychological problems (particularly stress, depression and significant rates of suicide) and premature return home. Pre-departure assessment is therefore important including medical and selective laboratory investigations. Psychological assessment should be deployed. Guidelines for pre-departure preparation including immunisations, chemoprophylaxis for malaria, safety and others are as for the short-term traveller with some modifications, which are discussed. Excessive alcohol consumption and a high rate of extra-marital sexual activity, including the risk of sexually transmitted diseases and HIV are common among certain groups of expatriates. The vexed issue of post-exposure HIV prophylaxis following occupational health exposure and sexual assault is discussed. Safety while abroad is an important issue including crisis management, risk of hostage taking and assassination, assault and kidnapping. Caring for expatriates in international settings is reviewed. Health care screening and management on return are discussed including the importance of debriefing and support. [ABSTRACT FROM PUBLISHER]