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Budahealth

Budapest_chain_bridge
The Chain Bridge, Budapest

– Betsy Wade

    As a site for a meeting on travel health, Budapest seemed to exert itself to teach by example.
    Take our arrival. Grasping passports to be welcomed into Hungary, the unsuspecting passengers of Delta 99, a nonstop from JFK, confronted a sportscreen-sized device called a thermographic camera. We were told to pause at the screen and then walk ahead.  Behind it two people swathed in paper O.R. outfits glared at the readings, frowned and waved us on, with no shred of welcome.
    But of course. As possible victims of H1N1, or swine flu, we were being checked for fever of 38 degrees C., or 100.4 F. How odd, traveling in the company of doctors and nurses, to be suspected carriers of a North American epidemic.
    So even before the first PowerPoint began, we were able experience one national response to fears of epidemic. Although the doctors, nurses and other clinicians at the conference considered inspection by thermographic camera perfect bureaucratic nonsense, there it was, as fixed as passport control.  

 

    It was May 23 and I was flying into Budapest for the 11th biennial conference of the International Society of Travel Medicine. I joined the group in 1989 when it formed. Then on behalf of The New York Times, every two years I  sat at the experts' feet in Zurich, Atlanta, Paris, Montreal and even New York. I signed up for this meeting to cull the best information for readers of Everett Potter's Travel Report.   
    Everyone on our flight was acquitted by the thermographic dingus. On another flight, Dr. Karl Neumann of Queens, a pediatrician and an editor for the travel medicine group, also breezed through although he might have attracted more interest if the gate-keepers had known his clinic had been treating at least a dozen children a day for probable H1N1. And of course, in a week when the banks of the Danube were swarming with 1,800 experts in public health, tropical medicine, altitude sickness, deep vein thrombosis and other disorders I shudder to think of, Hungary did register its first case of H1N1 — a Brazilian traveling from New York, who went to the hospital and recovered quickly.
    The lesson I draw from landing in Hungary is that overseas air travel has added one more harassment, which will probably continue, especially if the virus becomes more virulent before a vaccine emerges. So don't be surprised if some official asks you to say "aaah," or sticks a thermometer in your ear. But you might want to postpone a trip if you have a 100-degree fever. Budapest's next life lesson nudged me to get practical information for you.

Budapesttram

Photo by Betsy Wade    

    At one pause in the conference, I joined our adult grandson for a quick errand on the No. 6 tram from our hotel to the Great Market Hall  across the river in Pest. An older couple next to us, Hungarian, got off by the market hall, too. But as he stepped to the pavement, the man fell or collapsed. People rushed to help him as the woman stood by, but his legs seemed to fail him. The trams in both directions stopped. As the man was being assisted off the roadway, we decided we could be of no real help and left on our errand down Vaci Utca. Our grandson Mark found his postcards and I my book. Our walk and shopping took about 20 minutes. As we returned to the tram stop, a siren screamed behind us.
    Neither of us believed it took that long to get help, but sure enough, at the entrance to the market hall, there was the man who fell, on a stool, with the woman over him and several police officers alongside. He was being put into the ambulance as we boarded the No. 6 to recross the Danube. 
    I had come out for a quick errand. My passport was in the safe at the hotel. Any other ID I had would be of little use: What does an out-of-date NYPD press card mean in Budapest? If I were not with Mark, who would help me, and what would they know about my health if I collapsed on the street? Suppose something really got me and I had to wait 20 minutes for an ambulance?
    ISTM, the International Society of Travel Medicine, has an excellent online list of clinics (www.istm.org) that is usable, with the usual caveats, by nonmembers as well as members. Nice to peruse before a trip or if you get home with some persistent bug, but not useful on the tram tracks.
    My backstop for this situation is an unusual organization, the International Association for Medical Assistance to Travelers. This U.S-Canadian nonprofit organization survives wholly by contributions. It gives its members a pocket-sized 74-page directory of clinics around the world where English is spoken and that charge reasonable fees, which are outlined in the booklet. I throw the little book into my pack as a matter of course. Had it been me there on the pavement, and had all my medical friends left town, there are two entries for Budapest. Assuming I could point to a phone number, English-speaking help would probably come.
    I would consider the president of this organization, M. Assunta Uffer-Marcolongo,  an idealist too good to be true, except that I have known her for 20 years, and she's as selfless as ever and just as dedicated to the goals of her late husband, who created the organization in 1960. You may become a member and receive a directory — it is revised annually — as well as other useful information, at the online address: www.iamat.org. Membership is free but be sure to follow up with a contribution to the organization.
    In Budapest, I asked Dr. Elaine C. Jong, emeritus professor of medicine at the University of Washington, who is now head of the organization's medical board, how much she thought was appropriate. The president never says what the minimum is. Dr. Jong and I agreed that $100 wouldn't be wrong for the booklet and membership.
    A further question was raised by seeing the man on the pavement: Where are my medical records? Am I carrying my recent EKG, as my doctor told me to? Well, no. Who knows my allergies?
    Here is where a really good idea, in my estimation, is in the pipeline: a flashdrive with your medical data on it. Easy to carry, usable wherever there is a computer. Amendable. The commercial displays for the International Society of Travel Medicine convention included one for Care Plus, which the spokesman identified as a "tiny Dutch company." Along with familiar anti-insect products, it was displaying a flashdrive, or USB stick, containing software called Medikeeper.
    The agent said he had sold the gadgets for about six months, but had no U.S. distributors. So I bought a sample from him for $25 in Hungarian florints. I activated it on our laptop at the hotel. It works in five languages: German, England, Spanish, French and Dutch. On a couple of exploratory looks, I found it coherent and easy. Data can be kept secure from outside inspection, but that seems to defeat the purpose. It does not have a U.S.-style advanced medical directive or a medical proxy, but it does provide space for the names of people you identify as authorized to make decisions for you. 
    Since I travel with a couple of flashdrives on a lanyard anyway, it would be  easy to add a red one marked Medikeeper. But finding this product online looked like frustrating exercise.

    While I was brooding at the Care Plus booth, Dr. Stuart Rose of Northampton, Mass., president of a travel-product company, came by. He said his outfit, Travel Medicine, sells a similar new gadget on its Web site, www.travmed.com. This device, Traveler-ER — meaning emergency records — will not pop up on the site unless you enter that hyphen. It sells for $30. None were available at the conference, so I can't give you more information right now.
    Both of these devices, which I consider early versions of a good idea, work only with Windows. Flashdrives are cheap; it's the software that raises the price.
    Yes, indeed, some of the PowerPoint discussions about travel health were valuable and important, and there is more to say. But let me tell you, the basic travel health lessons were out there, in the airport and the street. 

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