‘Feel-good’ medicine: preparing for global adventures with Walter Reed's Travel Clinic

By Ann Brandstadter

WRNMMC Hospital Communications

Whether you are packing up for a Permanent Change of Station (PCS) in another country, heading out on a safari in Kenya, or embarking on a humanitarian mission, international travel can be an exciting experience. However, new destinations also bring new health risks. To keep Military Health System beneficiaries safe, the Walter Reed National Military Medical Center Preventive Medicine Clinic offers the Travel Clinic with both virtual and in-person visit options. Dr. James Mancuso, staff physician at Walter Reed and professor at the Uniformed Services University, calls it "feel-good medicine."

Any kind of travel can involve risk, from waterborne illnesses to environmental hazards.

“Everybody loves the Travel Clinic because the [travelers] are getting preventive interventions like vaccines, medications, and counseling and we're getting to find out about all the cool places where people are going,” said Mancuso.

The Travel Clinic is available to service members, their families, military retirees, and general schedule civilians traveling for work. The clinic plays a critical role in force health protection and overall readiness.

While many patients might go to their Primary Care Provider (PCP) for travel advice, the Travel Clinic has specialized resources to provide a more comprehensive assessment. The Travel Clinic offers virtual consultations lasting 30 to 45 minutes, as opposed to shorter (often 10-to-15-minute) consultations with PCPs, according to Mancuso.

U.S. Navy Cmdr. (Dr.) Teshome Tafes, service chief for Preventive Medicine, noted that clinic providers ask detailed questions about the traveler's itinerary: length of stay, planned activities, and accommodations.

During these comprehensive sessions, the medical team focuses on the three travel interventions: vaccines, malaria and other vector-borne disease prevention, and diarrheal disease mitigation. By addressing these essential areas, the clinic ensures that travelers are well-protected against the most common international health threats, according to Tafes. “The idea is to keep everyone healthy during travel.”

Travel Clinic counseling is customized to meet the conditions of each destination. For instance, a service member conducting outdoor fieldwork in Eastern Europe might receive the tick-borne encephalitis vaccine, while families heading to Japan or Korea for a PCS are counseled on the Japanese encephalitis vaccine.

“For example, I had one guy who was in Eastern Europe doing tick surveillance and there's something called tick-borne encephalitis there. This guy is a good candidate for tick-borne encephalitis vaccine that not everybody gets. He's trying to collect ticks so he's certainly at risk,” said Mancuso.

For those embarking on safaris in, for example, Tanzania, Kenya, or South Africa, providers discuss malaria medications and diarrhea treatments. For some locations, the team advises on high-altitude sickness, treating clothing with insect repellent, using bed nets, and use of the U.S. Department of State’s Safe Traveler Enrollment Program (STEP) for security.

"We shape our clinical encounter according to the exposures suggested by the patient’s itinerary, medical history, and other health concerns or questions," Mancuso noted, explaining that a week-long tourist vacation requires a different medical strategy than an extended stay visiting friends or relatives in a rural village.

Mancuso mentioned other medical risk factors that need mitigating. “There's a whole other set of things that we worry about, such as post-exposure prophylaxis (PEP) for HIV prevention among healthcare providers doing overseas medical missions,” said Mancuso.

One of the biggest hurdles to pre-travel care is simply finding the time to visit a clinic. The Travel Clinic reduces this barrier by offering its appointments via telehealth. Patients can conduct their comprehensive counseling sessions from their home or office (if it’s work related).

Once the virtual appointment is complete, the clinic sends the necessary prescriptions and vaccine orders to the military treatment facility closest to the patient's location. Travelers then go to their local clinic to pick up medications and receive their shots when most convenient for them, making the entire process seamless.

To ensure a smooth experience, the clinic recommends booking appointments early, ideally three to four weeks before departure, because some vaccines require time to build immunity before they are fully effective.

Additionally, travelers should gather their physical vaccine records and have them ready at hand during the clinic visit. While military personnel usually have up-to-date electronic medical records, civilian dependents and retirees might not, and having these records available avoids unnecessary vaccinations.

To reach the Virtual Travel Clinic, patients should call the Preventive Medicine Clinic at 301-400-0075 to schedule their visit.

For more information on the STEP program, visit https://travel.state.gov/en/international-travel/travel-advisories/smart-traveler-enrollment-program.html.

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