PENGANTAR
KESEHATAN PARIWISATA:
Tuti Parwati Merati
Divisi Ilmu Penyakit Tropik dan Infeksi, Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran, Universitas Udayana, Denpasar, Bali
PENGANTAR KESEHATAN PARIWISATA
SUB KAJIAN :
1. PENDAHULUAN
2. SEJARAH KESEHATAN PARIWISATA
3. DEFINISI KESEHATAN PARIWISATA
4. RUANG LINGKUP
PENDAHULUAN
Travel medicine
• is the branch of medicine that deals with the
prevention and management of health problems of international travelers
• It’s a new and important areas of medicine requiring
specialist knowledge, academic center and dedicated
clinical services to meet the health and medical needs
of the increasing number of travelers to cater for the
medical aspects of population movement related to
economic, politic and social factors
Travel Medicine is a unique specialty
• It is part of preventive medicine
• It includes
epidemiology of diseases
• It accommodates
curative care and self- treatment
Epidemiology Preventive Medicine
Self-Therapy
Travel Medicine
Pendekatan dalam Travel Medicine
TRAVEL MEDICINE
Tropical Medicine Infectious Diseases Internal Medicine Pediatrics
Geriatrics Obstetrics Dermatology Venerology Psychiatry Ophthalmology Otolaryngology Traumatology
Clinical Microbiology
Physiology (altitude, diving) Pharmacology
Traditional Disciplines
Specific: travel related Epidemiology Prevention
Self-Therapy Therapy
New Discipline
Robert Steffen, 1994
Mengapa kesehatan perjalanan perlu diperhatikan?
Semakin banyak orang yang melakukan perjalanan (travel)
Tujuan perjalanan semakin bervariasi
Risiko kesehatan berbeda-beda di seluruh dunia Pola risiko penyakit selalu mengalami perubahan Risiko kesehatan meningkat pada daerah tujuan
wisata eksotis dan yang jarang dikunjungi (adventure travel)
Semakin banyak wisatawan yang ingin mengakses pengobatan diluar negeri sambal berwisata
Sehat menurut definsi WHO adalah kesejahteraan (fisik, mental,social, spiritual) bukan sekedar tidak adanya penyakit atau kelemahan.
Faktor-faktor latar belakang perkembangan Kedokteran wisata
• Meningkatnya teknologi kedokteran, teknologi informasi, dan transportasi juga mempunyai dampak yang menimbulkan alasan untuk berwisata scope nya
semakin meluas, tidak hanya untuk “leisure” atau “holiday”, bertualang, tapi juga untuk tujuan yang lebih luas, antara lain untuk studi, bekerja, menengok keluarga atau teman, kebutuhan berobat, dan untuk “wellness” atau “wellbeing”. Jadi dari Kedokteran wisata menjadi Kesehatan wisata.
• Perkembangan industri pariwisata yang sangat maju akan mempunyai dampak :
• Peningkatan jumlah wisatawan, baik domestic maupun internasional.
• Peningkatan risiko kesehatan dan keselamatan pada wisatawan.
• Akan menimbulkan dampak pada kesehatan penduduk di daerah destinasi wisata
• Termasuk dampak pada lingkungan yang lebih luas, baik alam, social, budaya dan ekonomi
• Dengan demikian tuntutan terhadap destinasi wisata semakin meningkat, dan negara yang ingin mengembangkan pariwisatanya seperti tertantang untuk memenuhi tuntutan tersebut.
HISTORY OF TM
• The disciplines of TM evolved initially from infectious disease, tropical disease and preventive medicine
• Historically from quarantine and international health regulations
• The subject encompasses the whole range of clinical and preventive medicine; this includes care of the travelers with special needs such as, children, the elderly, pregnant women, and person with underlying medical problems: cardiovascular, respiratory, kidney, GIT, metabolic , neurological, malignant, HIV and behavioral dis.
• It is well known that medical students, nurses, doctors and other HCW in developed countries receive little training on tropical medicine and diseases and hazards outside their own environment.
HISTORY OF TM (2)
• Proposed by Jane Zuckerman :
the establishment of an academic centre on travel medicine at the Royal Free Hospital School of Medicine, University of London. The concept and the need of such a center was approved by the R&D Committee, education and council of the school, and
• The Royal Free Hampstead NHS Hospital Trust, supported the school ‘s initiative, and later the proposal for dedicated travel clinic to serve the staff, students and patients and the traveling public.
• in 1995 The Centre for Tropical Medicine and Vaccines was opened.
Why Travel Medicine is important ?
Increased trend of travelers
Why Travel Medicine is important?
• Scope : has largely evolved in response to changing of travel trend
• many more people are travel abroad,
• the reason for travel and types of travel has become much more diverse.
• Organized package tour remain popular, but many traveler are becoming more adventurous and choose to backpack out with ‘tourist‘ areas, go on expedition into remote areas sometime in several countries and work as volunteers for prolonged period.
• Travel for business take a common place.
• In addition, potentially vulnerable groups of people such as the very young, the elderly, pregnant women and those with underlying medical problems or disabilities and immunecompromized are traveling more than ever before.
• As a result of these changes: more people need
information, more advise and more prophylactic
prior and during travel
The Changes of Purpose of Travel
Health Status of Travelers
STUDI EPIDEMIOLOGI
Hasil penelitian menunjukkan bahwa dari antara 100.000 orang yang bepergian ke negara
berkembang selama +1 bulan 100.000 orang yang bepergian
--- 50.000 orang mengalami gangguan kesehatan
- --- 5.000 harus istirahat di tempat tidur --- 1.100 tidak dapat bekerja
--- 300 orang harus dirawat
--- 50 orang harus dievakuasi melalui udara --- 1 orang meninggal
Robert Steffen, 2003
TOURISM 2020 VISION
International arrivals are expected to reach +1.6 billion:
• 1.2 billion will be intraregional and
• 378 million will be long- haul
travellers.
The Continuum of Travel Medicine
During Travel Preventive Medicine
Contingency
Planning
Treatment &
Rehabilitation
Visitors Pre-Travel
Post-Travel
Perkembangan Kedokteran Wisata
Wisata kesehatan adalah kategori yang paling luas dari semua kemungkinan kategori aktivitas terkait kesehatan yang
melibatkan perjalanan.
Karena itu, wisata medis (medical tourism) adalah bagian dari wisata kesehatan.
Subset lain dari wisata kesehatan dapat mencakup wisata kuliner, wisata olahraga dll.
Definisi Sehat menurut WHO), kesehatan atau sehat adalah
keadaan kesejahteraan fisik, mental dan sosial yang lengkap dan bukan sekedar tidak adanya penyakit atau kelemahan.
Apakah Health Tourism Atau Wisata Kesehatan ?
Wisata medis, perjalanan medis
frasa ini tidak dapat dipertukarkan, namun digunakan secara bergantian, tetapi dengan arti yang sangat berbeda, oleh kelompok kepentingan yang berbeda, yang menyebabkan beberapa kebingungan saat ini.
Peneliti, ekonom dan ahli statistik pemerintah memiliki kebutuhan untuk mendefinisikan pariwisata medis dalam istilah ekonomi dan sosiologis.
Profesional medis, penyedia perawatan kesehatan, penyedia layanan perjalanan medis, dan perusahaan kebugaran memiliki kebutuhan yang berbeda, relevan dengan layanan terkait medis dan kesehatan yang mereka tawarkan.
Istilah tourism (wisata ) dan travel (Perjalanan)
seperti Medical tourism, medical travel
Bagaimana perkembangan selanjutnya, sehingga muncul istilah medical tourism ?
Globaliza tion
Consumerism
Technology
Medical Tourism
Contoh model pendorong
perkembangan medical tourism
A continuum of care
Medical tourism
• Medical Tourism refers to people traveling abroad to obtain medical treatment.
• In the past : usually refer to those who travel from less developed countries to major medical centres in highly developed countries for treatment unavailable at home.
• However, in recent years it may equally refer to those from developed countries travel to developing countries for lower priced medical treatment (liver
transplant in USA costs $ 300.000, compared to $91.000 in Taiwan), or medical services unavailable or non licensed in the home countries, or because long
queue wait times at home countries ( 26 week for hip replacement and 16 week wait for cataract surgery in Canada).
• Most often is for surgeries, cosmetic or otherwise, or similar treatments, though people also travel for dental tourism or fertility tourism.
• History : Greek pilgrims travel from Eastern Mediteranian to a small area in the Sarconic Gulf called EPIDAURIA… this territory was the sanctuary of the healing God Asklepios.
Wellness Tourism
• The report defines wellness tourists as those who travel from home to proactively pursue activities for personal health and wellbeing and seek unique,
authentic or location-based experiences and therapies not available at home.
• It recommends that the term health tourism not be used to describe wellness tourism. Certainly, in the
context of the WHO definition, wellness tourism is not health tourism. It is a subset of health tourism.
• The report makes an interesting observation that
wellness businesses prefer to use the word “guest”,
not “patient,” and focus on ambiance and experiences
rather than outcomes.
Summary
• The scope of Health tourism (Wisata Kesehatan)is wider than just medical tourism (wisata medis).
• It is included of medical and non medical professional (wellness tourism).
• Medicine just only one aspect of the health tourism.
• Non medical aspects of tourism, such as
accommodation, restaurants, tourist destination
safety , etc are important aspect
Perkembangan Travel Medicine (Kedokteran Wisata)
• Travel Medicine (Kedokteran Wisata)
• Travel Health (Kesehatan Wisata) : Medical tourism, wisata medis
• Health Tourism (Wisata Kesehatan) : Lingkup paling luas : termasuk wisata medis dan wellness tourism
• Kesehatan Pariwisata adalah : cabang ilmu kesehatan masyarakat yg mempelajari berbagai aspek yg berkaitan dg kesehatan wisatawan, kesehatan masyarakat daerah pariwisata maupun semua pihak yg terkait dg industri pariwisata.
• Sering kali ada pemakaian istilah yang masih rancu, jadi harus
disepakati dulu apa yang dimaksud.
TRAVEL CLINIC : Pre-Travel Consultation, DURING TRAVEL and POST TRAVEL
•
To give updated and accurate advices to
travelers prior to their trip regarding the health risk and its prevention.
•
To assess the traveler’s fitness for travel.
•
Communication while away : DURING TRAVEL
•
Post Travel assessment
Principles of TM Practice
• Identify general and specific risks for traveler
• Provide specific advice about hazards which may lead to appropriate behavioural change
• Recommend specific risk reduction interventions with perspective of priority (vaccine, medications
,repellants)
• Provide preventive interventions safely and efficiently
• Provide the mechanisms for safer management of
illness while traveling and on return
Identifying high risk individuals
Certain individuals may be at higher risk of acquiring travel illness, be at risk of more severe disease, or have contraindications to certain vaccines or
medications.
- Pregnant women - Children
- Patients with chronic medical conditions (eg. diabetes, heart disease, respiratory disease)
- Immune suppressed patients, including those with HIV infections - Those taking stomach acid suppression medication
- Elderly travellers
- Expatriates and long term travellers - Travellers visiting friends and relatives.
Providing health education
While there are issues relevant to all travellers, not all travellers are at risk of all problems, and the risk assessment should guide the particular areas for education and advice, by indicating what is relevant to the individual.
Common issues to be discussed for all travellers are:
• eating and drinking safely
• insect avoidance
• traveller’s diarrhoea management
• dog bite management, and
• the need for travel insurance.
Specific topics , eg. Safe sex practices, alcohol intoxication ,DVT, altitude illness, etc
Potential issues in travel advice/education
Risks in Travel
Non Communicable Risks
• Aircraft travel, reduced O2, pressure and humidity
• Motion sickness
• Jet Lag
• DVT’s and immobility
• Altitude
• Heat/cold/humidity
• Sunburn
• Water safety
• Accidents and Injuries
• Alcohol drinking habit and safety (methanol intoxication)
• Animals and Insects
Potential issues in travel advice/education
Communicable Risks
There are many potential diseases spread via :
• Food and water
• Insect vectors
• Soil and water
• Sexual contact, Body-fluid exposures
• Animals
Potential issues in travel advice/education
Communicable Diseases No vaccines
• Dengue
• HIV
• Amoebiasis
• Filariasis
• Novel /New H1N1
• Avian Influenza
• Others: ciguatera, legionella, leptospirosis,
meliodosis, Typhus, strongyloides, hookworm, hep-E,
schistosomiasis
Potential issues in travel advice/education
Communicable Diseases Vaccine Preventable
Routine background
• Diphtheria/tetanus/pertussis
• Polio
• MMR Varicella
• Influenza Travel Related
• Hep A and B
• Typhoid
• Cholera
• Japanese Encephalitis
• Rabies
• Tuberculosis
Selecting appropriate vaccination
Recommendation of vaccines should follow simple principles, should be based on travel illness epidemiology, and be acceptable to the traveller’s needs and budget.
• Update any routine vaccinations relevant to country of destination
• Recommend any vaccines relevant to usual daily lifestyle and work
• Consider travel vaccines, and make recommendations based on specific risk.
Preventive medications
• The decision to advise the use of antimalarials is dependent on the level of risk, but all travellers in malaria prone areas must have advice about mosquito avoidance and basic malaria facts.
• The various medications all have advantages and disadvantages. Consideration of the level of risk, the respective contraindications, likely side effects, compliance issues and cost will influence the final choice.
• A trial of medications may be required and should be done well in advance of departure to assess tolerability. Providing medications for self treatment of suspected malaria is an option that may be suitable to some travellers, but requires intensive education.
Medical kits and health products
• Traveller’s medical kits are part of good preparation.
They contain prescription and nonprescription medications and first aid items to treat common travellers' ailments early and avoid complications or need for accessing treatment while travelling.
Typically they deal with gastrointestinal and
respiratory infections.
Documents needed
References
• Supercourse on Travel Medicine
• ^ WHO Travel Information
• ^ CDC re: Yellow Fever
• ^ CDC re: Meningococcal Meningitis
• ^ CDC re:Malaria
• ^ "Health risks and precautions: general considerations - Contents of a basic medical kit". International travel and health. Geneva: World Health Organization. 2010.
http://www.who.int/ith/ITH2010chapter1.pdf .
• External links
External links
• CDC Travelers' Health -includes information on destinations, outbreaks, and recommended or required vaccinations
• International Association for Medical Assistance to Travellers (IAMAT)
• International Society of Travel Medicine (ISTM)
• WHO - List of Country Members - includes information on outbreaks
and health profiles
Ruang lingkup Kesehatan Pariwisata
Wirawan, IMA, 2020
