Illness and Injury to Travelers and Access to Dental Care on a Research Expedition to Mongolia

Authors

  • Marc TM. Shaw FRGS, FRNZCGP, FACTM, FFTM ACTM, FFTM RCPS (Glasg),

    Corresponding author
    1. Worldwise Travelers Health Centers of New Zealand, Auckland, New Zealand and School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
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  • David Daniels BDS, LDS RCS (Eng),

    1. Department of Orthodontics, Royal Bournemouth Hospital, Dorset, England, UK
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  • Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM ACTM, FFTM RCPS (Glasg)

    1. School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Marc TM. Shaw, FRGS, FRNZCGP, FACTM, FFTM ACTM, FFTM RCPS (Glasg), Worldwise Travelers Health Centres of New Zealand, Auckland, New Zealand. E-mail: doctors@worldwise.co.nz

Abstract

Background Expeditions provide an opportunity for travelers to undertake specialized travel to more extreme destinations in the security of an expeditionary group with medical coverage. Little is known about the illnesses and injuries occurring to expeditioners in Mongolia or access to dental care in the local population. This study was designed to investigate the prevalence of health problems suffered by travelers and managed among the local population on a research expedition to Mongolia.

Methods In June 2005, the expedition physician (MTMS) and dentist (DD) prospectively diagnosed and recorded all illnesses and injuries among 16 travelers (eight males and eight females) as well as any indigenous people on a 22-day paleontological expedition to the Mongolian Gobi Desert.

Results There were 53 health presentations and 14 dental problems among the indigenous population and the Mongolian escort. Males and females presented in equal proportions with the average age of 49 years (SD = 16). Presentations involved locomotor/accident (32%), dermatological (23%), gastrointestinal (19%), neurological (17%), psychological (6%), and with other systems (11%). Most accidents were due to lacerations (85%). Presentations were highest on days 4 and 5 (10% or 18%). Females were significantly more likely to present later in the expedition (p= 0.013). One quarter (25%) were handled conservatively with 28% requiring topical treatments with others requiring antiemetics (9%) and anti-inflammatory drugs (4%). There were no dental concerns reported among the expeditioners, although there were 14 cases among the indigenous population. While there were no deaths on the expedition, there were two major incidents, one of which required emergency evacuation.

Conclusions The health problems encountered were largely similar to those reported for other expeditions. The most common problems included trauma as well as dermatological, dental, gastrointestinal, and neurological conditions. It is important that expedition teams are prepared to manage common problems, such as trauma and dental lesions.

The United Nations World Tourism Organization estimated that there were a record 0.9 billion international tourist arrivals in 2007.1 People are also traveling further afield.2. Although there has been a move in recent decades for fewer people to go on programmed package tours,2 expeditions provide an opportunity for travelers to undertake various specialized travel to more adventurous destinations in the relative security of an expeditionary group. These expeditions will often have both an experienced team leader and a designated expedition physician or nurse3,4 and less commonly a dentist. Research expeditions can provide opportunities for travelers to go to more remote and unusual destinations to undertake philanthropic or professional pursuits. With any expedition, it is important that travelers seek pretravel health advice and take out appropriate travel insurance, where this is not covered by the expedition.

It is known that about 50% of travelers encounter some kind of health and safety problem while they are traveling to developing countries.5 Usually, common problems occur commonly among travelers, such as gastrointestinal illness, which affects approximately 50% of travelers.5 As expected, common problems encountered on expeditions appear to relate to the type and level of difficulty of the expedition, nature and health of the expeditioners, and the region into which the expeditioners travel. In several studies of youth expeditions, diarrhea, nausea and vomiting, upper respiratory tract infections, headache, and trauma appeared to be the most common presentations.6–8 In an Arctic youth expedition, falls appeared to be the most common accidents resulting in trauma.7 Common presentations on an expedition to the Amazon related to ear, nose and throat conditions, injuries, bites and stings, as well as respiratory, dermatological, and gastroenterological problems.9 Similar problems have been found in wilderness expeditions in Alaska10 and a premium expedition to Iceland.11 Deaths occur infrequently on expeditions4,7,9 and evacuations of expeditioners have rarely been documented.10

Little is known about the illnesses and injuries occurring to expeditioners in Mongolia or access to dental care in the local population. This study was designed to investigate the prevalence of health problems suffered by travelers and the access to dental care in the local population on a research expedition to Mongolia.

Methods

In June 2005, the expedition physician prospectively diagnosed and recorded all illnesses, injuries and dental consultations among the 16 travelers as well as local Mongolians (who were either part of the research team or encountered on travel through the region of research interest) on a research expedition to Mongolia. Information recorded included age, sex, whether local or not, number of days into the expedition, the nature of the presenting illness, whether an accident was involved, the assessment of the condition, and the treatment employed. The period of the expedition was for 22 days, and travel was primarily by land transportation using local vehicles. Data were coded using a standard spreadsheet program (Excel). Data were then analyzed using SPSS Version 14.0.1 for Windows (SPSS Inc., Chicago, IL, USA, 2005).

Results

There were 53 health presentations reported and recorded among the 50 consultations of travelers on the expedition, including 10 within the Mongolian population who had dental problems. Males and females presented in almost equal proportions with the average age of expeditioners presenting being 49 years (SD = 16) compared with the overall average age of the expeditioners, which was 57 years. Table 1 gives the demographic characteristics of the conditions treated on the expedition. Nearly one third of presentations were by local Mongolians (30%), who were a significantly younger group (p= 0.004).

Table 1.  Demographic characteristics of the conditions treated on the expedition
 Age groupTotal
20–2930–3940–4950–5960–6970–79
Sex
 Male1011110427
 Female113251426
Total12313161853
Percentage22.65.724.530.21.915.1100.0

The types of primary illness diagnosed were largely those related to the following systems: superficial trauma (25%), dermatological (23%), gastrointestinal (19%), neurological (17%), psychological (6%), and dental and other problems (11%). Of the superficial trauma, most involved lacerations (85%). There were two medical emergencies: an acute allergic reaction to the local arak alcoholic drink, made from fermented mare’s milk and a severe leg laceration requiring evacuation for further medical care. Of the dental patients, one third involved periodontal conditions.

Dental patients, all Mongolian, were usually treated sitting on a low box, bucket, or stone with the assistance of another expedition member or one of the patient’s family supporting the head. Four of the Mongolian members of the expedition team were treated and 10 of the rural Mongolians. The standard of oral hygiene in the populace managed was generally good and usually toothbrushes and toothpaste could be seen in the living quarters of “gers.”Table 2 shows the demographic characteristics of the dental patients.

Table 2.  Demographic characteristics of dental patients treated on the expedition
 Age groupTotal
0–1920–2930–3940–4950–5960–6970–79
Sex
 Male30020005
 Female04302009
Total343220014
Percentage212921141400100

Dental extractions (16), carried out under local anesthetic, were all due to caries. There were two temporary fillings and two presenting for orthodontic advice. Scaling was carried out on four patients. There was one refusal of treatment. Caries was often present in only one to two teeth in an otherwise healthy mouth. Dental decay in children was often very hard to manage by the expedition dental and medical staff and was left untreated in the absence of pain. There was little crowding of teeth or evidence of early deciduous tooth loss. Extractions were requested of restorable teeth because of inability to access dental treatment, inability to afford the cost, or simply that they did not want them filled.

Presentation frequency was highest on day 4 and then tended to reduce toward the end of the expedition. This is graphically represented in Figure 1. Females were significantly more likely to present later in the expedition (p= 0.013).

Figure 1.

Graph showing medical presentations by day of the expedition.

About one third of the local presentations involved headaches with possible underlying high blood pressure (31%). Another one fifth involved superficial trauma (19%). Nearly half of the presentations reported involved accidents (49%).

Dental patients among the Mongolian staff increased as they became less afraid. Because of the sparse population density (0.28 per square km), the treatment of locals depended on finding them or their finding the expedition in the desert.

One quarter of presentations (25%) were handled conservatively with 28% requiring topical treatments, 9% requiring antiemetics, and 4% requiring anti-inflammatories. There were no deaths, but there were two major incidents requiring emergency assessment; one was an acute allergic reaction and the other a laceration to the lower leg, sustained after a fall down some stairs. This latter patient, a 75-year-old woman, was evacuated, accompanied by a nurse from the expedition, back to Ulan Bataar, the capital of Mongolia, for ongoing management.

Discussion

The health problems reported on this research expedition to Mongolia were generally similar to those reported for other expeditions,6–13 although superficial trauma was a more prominent feature. No conditions were referred for local medical advice, as the present expedition had the services of an expedition physician and dentist.

As expected, common problems occurred commonly and the types of illness were largely those related to trauma, as well as dermatological, dental, gastroenterological, and neurological conditions. Accidents were a prominent feature on this expedition, which resulted in mostly superficial trauma. The spectrum of conditions seen were similar to health problems experienced by expeditions and travelers more generally to developing countries.9,12 Presentations peaked early in the expedition, although expeditioners presented with various problems virtually throughout the expedition, decreasing toward the end. Conditions related to biting insects and occasional stinging plants, which have plagued other expeditions,7,9,12,13 were also a feature on this expedition.

On expeditions to countries like nontropical Mongolia, tropical diseases are not an issue, though tropical diseases are also not commonly reported on expeditions to developing countries in the tropics.6–9,12,13 Fortunately, cardiovascular presentations and metabolic presentations were nonexistent; however, a number of local Mongolians presented with conditions possibly related to underlying health problems, such as high blood pressure. The inability to provide ongoing management of health problems in local populations has been found to be a challenge for many expeditions.3,9

Interestingly, accidents were common among travelers on this research expedition, as has been found on other expeditions.7 Accidents can be minimized through careful planning and preparation;3 however, physical demands of the expedition, unfamiliar terrain, the unknown, often harsh environment, and preexisting conditions may have contributed to at least some of the accidents reported on this research expedition, in addition to the treatment of trauma among some local people.

Dental problems are a relatively common problem among travelers.14,15,16 However, no dental treatment was required for the travelers on this expedition, which may have reflected a higher degree of preparation than expected for expeditioners compared with travelers in general. In addition, little general dental treatment was required for the managed Mongolians. Their diet contains a high proportion of dairy products, including milk and cheese and yogurt from yak, camel, goat, sheep, and cow. In addition, they consume little sugar compared with that of similar groups in the Amazon.17 While research expeditions such as this present an opportunity for medical and dental philanthropy, the Royal Geographical Society strongly recommends expedition physicians against undertaking this type of care.18

This study represents an analysis of data collected from expedition members on one research expedition to Mongolia. This group may have encountered different hazards and risks from other groups of travelers and expeditions. Generalization and extrapolation of this data are therefore limited. Nonetheless, this data can be useful in developing a health risk assessment for expedition planners, especially to this region.19 For example, the use of pharmaceuticals on this premium expedition could be targeted to respiratory, gastroenterological, and dermatological conditions, while simple first aid measures need be applied to the principally minor trauma that is experienced.

Conclusions

On this research expedition to Mongolia, the health problems encountered were largely similar to those reported for other expeditions. The most common problems included trauma as well as dermatological, gastrointestinal, dental, and neurological conditions. The inclusion of both an expedition physician and an expedition dentist on this research expedition increased the independence of the travelers on this journey to remote areas of Mongolia, where health services were scarce or nonexistent. This study underlined the importance of expedition teams being prepared to manage common problems, such as trauma.

Declaration of Interests

The authors state that they have no conflicts of interest.

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