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How to prepare and conduct your medical missions trip safely.
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Food and Drink Safety
4-10 AMLT - Honduras 1
Hugh J. Davis RN, MHA,MPH Betsy Christiansen BSN, RN
In the field, remember:1. Eat to stay healthy!2. Follow safe water protocols.3. Protect yourself from blood-borne disease.4. Follow basic immunization schedules.5. Know how to diagnose & treat travelers’ diarrhea.6. Follow malaria protection protocols.7. Protect yourself from TB.
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Pathways to Infection
Water Food SkinMucous Membranes
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4
Universal Precautions… …what’s wrong here?
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Universal Precautions
What’s right in this picture?
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It’s been said,“Travel broadens the mind as it loosens the bowels!”
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MTW Medical Team Goal:
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>90% of our medical teams have achieved that goal!
0% incidence of diarrhea and
THINK Before You Eat!!!
Everything that looks good may not be safe.
That which looks unpalatable may be safe.
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Boil it, Cook it,Peel it, or…Forget it!Giardia
trophozoites104-10 AMLT - Honduras
Only 2% of travelers are compliant!
53% use ice in drinks;71% consume uncooked vegetables;40-60% get diarrhea!
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An Unwanted Part of the Missionary Experience
Julie: 9 mo diarrhea 4-5 days per month 10% weight loss
Laurie: 1 year Giardia 2 week hospitalization
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Hepatitis Polio Typhoid fever Protozoa Bacteria Viral enteritis
What does Cipro cover?
Your body is not your own; you were bought with a price.
1 Cor. 6:20
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‘Sacrificial gifts’ from donors lead to loss of…• a caregiver’s time• a translator’s time• a transportation unit• a team’s productivity… or even • a potential cancellation of trip.
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Wash your hands before you eat!
Water from any spigot, tube or pipe
is considered contaminated!DON’T wash your dirty hands in
contaminated water and with contaminated soap; don’t use a contaminated
towel for drying!
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Water Hygiene
Water from spigot is considered contaminated…
…you don’t know the source!
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Safe Alternatives for Hand Washing
Wash in disinfected “clean” water.
Use antibacterial soap.Air dry or use your own “camp towel”.Use jellied alcohol.
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Are We Ready to Eat?
Eat with “clean hands”! Don’t use dirty utensils,
dishes or cups!What’s dirty?What’s clean?
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The ‘Tupperware Alternative’ A sealed container with your own utensils inside;
A 3-step wash using disinfectant.4-10 AMLT - Honduras 20
What’s For Supper?
Ascaris Giardia
Amoebas Taenia
Hepatitis
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ALWAYS Unsafe… …NEVER eat!
Salads (lettuce)
Custards Potato salad Mayonnaise
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4-1023
More Unsafe Foods
Milk products…butterice cream unpasteurized cheese
Raw or undercooked meat & fish
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Safe Foods
MUST be well-cooked cooked to
158º & hot at serving time
MUST be reheated to 158º if previously cooked Jellies & breads (covered - no
flies!) 254-10 AMLT - Honduras
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Dry Things are Safe…
…If packaged or protected properly!
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Heat Kills Germs!
Staphylococcal Food Poisoning is from a heat-stable Toxin.
MUST keep hot foods hot (> 140ºF)… …and cold foods cold (<40ºF).
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Initial symptoms:
Staph Toxin 1-8 hrs
E Coli 0157 4 +days Giardiasis 1-2 wks
Amoebiasis 2-4 wks
Hepatitis A 2-6 wks Ascariasis 4-16
wksTaeniasis 2 mo
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Thursday, Day 4
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What About Fruit? Is the outside of the fruit clean?
Was the knife clean that cut the
fruit? (2-knife method?) Were the hands clean that prepared the fruit? 334-10 AMLT - Honduras
Not all Fruit is Created Equal!
Best = fruit with rind or skin
that can be peeled
Easy Very easy
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Difficult or impossible to clean
DifficultAlmost impossible 354-10 AMLT - Honduras
Not all Fruit is Created Equal!
Raw vegetables such as lettuce, spinach, tomatoes and onions were responsible for the illness or deaths of nearly 19,000 people nationwide over a 5-year period.
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What is Safe to Drink?
Hot beverages: boiled water,
tea or coffeeSoda & carbonated beverages
Coconut water or milkPasteurized milk & juices
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11 of 14 randomly-selected bottles representing 8 brands in Nepal were contaminated with Coliforms!
The Story on Bottled Water
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Outbreaks of diarrheal illness are common from “safe” bottled water.
[Wisconsin, Lima, Mexico and Peru’s “San Antonio”]
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The Story on Bottled Water
Is it safe or… Has it been rebottled? …refilled? Safety designation e.g., reverse osmosisBottle dirty? …wet? Cap secure? …new or replaced?
Do you trust your life & your team’s health with it ?!404-10 AMLT - Honduras
Drinking-water on AirplanesA substantial number of aircraft
going to / returning fromdeveloping countries serve
contaminated drinking water.
Travel with “Sweet Water” drops,
Iodine or Chlorine Dioxide tabs, or a “Steri-Pen”. 414-10 AMLT - Honduras
Coconut Water…
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…it’s always in good taste …& all over the world!
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Cleaning Dishes… a Triple Process
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Other Water Challenges
Brushing teethShowering
Swimming poolOcean
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High Risk Behavior
Bad information or ignoranceNon-compliancyEating in “dirty” restaurants
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Prevention… Active vs Passive
Dietary Restrictions
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Prevention Active vs Passive
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Active verses Passive Restrictions
Passive = everybody orders for themselves, then leader must tell them no!
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Active = Eat everything that is put in front of you
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So-o-o… what-R-U-gonna-eat?
Iced tea?Hot soup?
Lettuce?Tomato?
Banana?
Hamburger?Bun?
Silverware?Napkin?
Spoon?
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What if you are served unsafe food?
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What if you are served unsafe food?Try not to offend.Eat small portions. [risk of diarrhea linked
to size of inoculum] Have a designated eater. [someone w/ indigenous bowel
flora]
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Taking 500mg Cipro after eating will NOT
protect you from crypto, Hepatitis
A, rotovirus, etc.
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If you can’t live without cut fruit, salad, ice or fruit juice for 2 weeks…
…stay home!!!
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Food at luxury hotels no safer than the food in standard hotels.Flies are important vectors of disease. Watch for flies in the restaurant & on food!
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Food consumed on aircraft home was likely prepared in country of origin of the flight. If eating is unavoidable, limit intake [inoculum]!
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Epilogue
If you can sleep well & eat well, you can endure almost anything!
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Let’s Eat !!!
Good, Safe Food in Jungle Kitchen
59
You CAN stay healthy!
1. Think, Think, THINK !!!2. Think as a group !3. Look out for each other !4. Choose food carefully !5. Treat water appropriately !
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