International Travel to Deliver Healthcare in Resource-Limited Settings

Healthcare workers practicing in resource-limited settings outside the United States face unique health hazards, including exposure to infectious disease threats through interactions with patients, contact with the healthcare environment, or by handling clinical specimens. Any type of healthcare worker (e.g., ancillary clinical staff, nurses, physicians, veterinarians, public health personnel, researchers, students, and trainees on international rotations) working in clinical areas or handling specimens can be at risk (Box 8.2.1). Certain extremely resource-limited settings, such as humanitarian emergencies, present specific challenges and risks to healthcare workers (Box 8.2.2). Box 8.2.1. RISKS FOR HEALTHCARE WORKERS TRAVELING INTERNATIONALLY TO PRACTICE IN RESOURCE-LIMITED SETTINGS ★: Challenging practice conditions (e.g., extremely resource-limited settings, natural disasters, or conflict zones) that can prevent healthcare workers from adhering to Standard Precautions. Greater prevalence of transmissible infections (e.g., hepatitis B virus, hepatitis C virus, HIV, tuberculosis, antimicrobial-resistant pathogens) with potentially increased transmission risk from untreated source patients. Less stringent safety regulations or infection prevention and control standards. Limited availability of personal protective equipment, safety-engineered devices, or post-exposure management resources. Unfamiliar safety risks, practice conditions, equipment, or procedures. Box 8.2.2. HEALTHCARE WORKERS IN EXTREME CIRCUMSTANCES ★: Healthcare workers regularly provide care in a range of extreme circumstances, which can be characterized by limited or absent medical and public health infrastructure; lack of fundamental hygiene supplies (e.g., soap and water for handwashing); increased infectious disease transmission risk; overcrowded medical wards which lack good ventilation systems; challenging environmental conditions; and high levels of violence. According to the Aid Worker Security Report from Humanitarian Outcomes, in 2022, there were 444 attacks against aid workers, with 116 killed, 143 wounded, and 185 kidnapped. Because of the increased risks and consequences of severe disease or injury, adequate prevention and preparation are essential. Health problems for the healthcare worker can have serious implications, both for the person and for those who depend on the healthcare worker for provision of health care. Detailed instructions on how to prepare for travel or work in developing countries or humanitarian environments is covered in other sections, but additional key considerations for healthcare workers include the following: Reliable communication equipment: Usually a satellite phone, ensuring service provider contract for duration of the mission. Consider portable solar recharging capabilities unless guaranteed a power supply, which is rare in most extreme circumstances. Evacuation insurance and a plan for ill or injured worker: Not all deploying organizations provide evacuation insurance or a detailed evacuation contingency plan. Both are critical, and the healthcare worker should be familiar with all details. Underlying health conditions of the worker: Monitor the provider’s health closely and initiate treatment early, if necessary. Any indication that a potentially serious condition is not responding to treatment should warrant rapid planning for potential medical evacuation. Psychological stability of the worker: Providers in conflict and disaster zones typically work long hours under dangerous conditions and are exposed to profound suffering. These experiences can be intensely stressful, leading to increased rates of depression, post-traumatic stress disorder, or anxiety. Before deployment, providers should think about coping strategies and, as much as possible, stay in contact with a support network of family and friends. Chemical warfare agent antidotes: Although rare, healthcare workers could be exposed to chemical warfare agents while caring for patients. If exposure to these agents is a possibility, antidotes (e.g., atropine) should be immediately available. Infectious agents can be spread through contact with blood, bodily fluids, respiratory secretions, or contaminated materials or surfaces. Healthcare workers might be exposed through contact, percutaneous, or inhalation routes. Risks vary depending on assigned duties, geographic location, and practice setting. Of note, healthcare workers working abroad can be at risk for exposure to patients with emerging, highly pathogenic, or uncommon infectious diseases (e.g., Ebola disease, Middle East respiratory syndrome [MERS], or extensively drug-resistant tuberculosis). For more information, see Post-Travel Evaluation to Rule Out Viral Special Pathogen Infection.