Arch Parker, vice president, special ventures, for Monumental General Insurance Group in Baltimore, Md., is preparing to take a small group of top producers and their spouses on safari in Africa. Parker's previous incentive destinations include Hungary, Russia, Turkey, Greece, and Indonesia.
A year ago, Charlotte Stott, senior vice president and national sales manager for London Pacific Life Annuity Company in Sacramento, took a group of PPGAs to South Africa with a similar program. Stott's incentive travel history includes trips to Hong Kong, Bangkok, Australia, and New Zealand.
Parker and Stott are part of a fast-growing segment of insurance conference planners organizing "high adventure" trips, as Stott calls them. With the warm and sunny spots close to home no longer exciting some potential qualifiers, planners are pulling out their world atlases and heading for the historic and the exotic.
Offering these greater rewards naturally involves greater risks. Put aside for the moment the daunting logistical challenges of planning overseas incentives--language barriers, time differences, unfamiliar cultures and cuisines--and consider the professional conference planner's responsibility for attendees' health. The following is a guide to incorporating those considerations into the meeting planning process.
Exotic Travel Increases Health Risks Accidents aside, overseas travel has inherent health risks--some serious, some annoyances. These include jet lag, traveler's diarrhea, food poisoning, hepatitis, cholera, yellow fever, pneumococcal diseases, bacterial infections, rabies, malaria, snakebite, heatstroke, and sunburn. Those related to food and drink present the biggest health risks because they are the hardest to control. Encourage attendees to strike a balance between adventures in eating and prevention of illness.
But hold on. Should insurance meeting planners, most of whom host first-class affairs, use five-star hotels, and seldom get too far off the beaten track, really be concerned?
Yes, says Fran Lessans, RN, MS, president of Passport Health, a travel medicine center headquartered in Baltimore. A five-star hotel, she believes, offers planners no ironclad assurances. Another misunderstanding she clears up: Vaccination requirements set by a foreign country for entry into that country are designed to protect nationals from the diseases of visitors--not to protect travelers from diseases common to that country. Lessans, who is establishing franchises around the country, shares anecdotes gathered from personal travels and those of clients:
* An American seeking treatment at a clinic in Egypt sees the doctor wipe a needle on a handkerchief to clean it.
* A traveler to the Philippines becomes ill after eating a watermelon that a vendor had injected with river water to increase its weight for sale.
* A man staying in a deluxe Far Eastern hotel sees an employee blowing open "sterile" cellophane bags used to wrap bathroom drinking glasses.
"Conference attendees spending a few days at a five-star hotel in China don't run the same level of risk as someone who will be staying for several months and going to remote areas," Lessans says, "but we believe the only way to get maximum enjoyment out of a trip is to know about and prepare for the travel risks."
Jonathan Spero, MD, founder of Atlanta, Ga.-based InHouse Physicians, which provides a variety of on- and off-site medical services at largeand special events, agrees.
Dr. Spero says the biggest problems in, for example, underdeveloped areas of Africa, Asia, and South America, are the lack of uniformity in medical care and the time it may take to obtain appropriate medical care. "Critical injuries are infrequent but of the gravest concern," says Dr. Spero. "The most common problems, however, are non-emergency situations involving gastrointestinal problems, upper respiratory infections, muscular skeletal problems, and allergic reactions."
Other problems arise from language barriers, substandard medical training, a shortage of medicines, counterfeit or poorly prepared medications, and travelers who simply are unaware of or ignore health risks.
The Legal Angle As the trip leader, you have another issue to consider: liability. "The professional meeting planner is being held to an increasingly higher standard of care," says John S. Foster, JD, CHSE, an Atlanta-based lawyer specializing in meeting planning. "This can involve serious liability issues if they fail in their responsibility to ensure, to the extent possible, the safety and well-being of participants once they get to a destination and, in some cases, before they arrive."
Foster notes that some case law exists in this area but that a great many cases are settled out of court. Still, he warns, planners have a legal obligation to
(1) investigate all aspects of a planned event and act accordingly,
(2) inform and warn attendees of known health and safety hazards,
(3) plan for attendees' safety and well-being, and
(4) not subject attendees and participants to unreasonable risks of harm.
"Investigate people and companies you do business with," Foster advises. "Check out your liability and insurance risks. Have an attorney review planned activities to point out potential liability." Also: Transfer risks through "hold harmless" and indemnification clauses and waivers and make sure you are adequately insured--probably not a problem for this industry!
Know Before You Go Careful planning for attendee health starts with sharing current and comprehensive destination information with conference qualifiers so they can assess their own risks. Adhere to the basic principles of risk management, and create complete contingency plans.
That means site evaluation, research, homework, lists, and more lists. Check with the Centers for Disease Control and Prevention (CDC) or the U.S. State Department for advice on health risks in the area to which you will be traveling. Put together a basic medical kit with moist towelettes, bandages, gauze, tape, thermometer, scissors, tweezers, acetaminophen, ibuprofen, antibiotic cream, diarrhea medicine, insect repellent, and sunscreen. Find out about emergency medical services on site and know the locations of hospitals. Know how to find English-speaking physicians, and consider having certain medical documentation translated into the language of the destination country. You might even check on emergency medevac services.
"Unfortunately," says Dr. Spero, "this is a neglected area. Many companies are clueless. They know the risk is there but they are in denial, just hoping something doesn't happen."
But the solution can be simple: Deal with experts who understand the issues, take their advice, and relax. Such expertise comes in several forms. Passport Health, for example, is one of a number of travel clinics springing up in response to the need for timely information, specialized vaccines not normally stocked by general practitioners, and travel medical supplies.
Such clinics consult with travelers, obtain medical histories and trip activities, inform them of (and often administer) the vaccines required or suggested by the CDC, and provide a little yellow booklet called the International Certificate of Vaccination (ICV). They also can provide printed information on the health status of countries being visited.
Recently cited by the Washington Post for the comprehensiveness of its approach, Passport Health gives each client a health briefing booklet containing vaccination details, information about diseases the traveler may encounter, the destination's health status, and general travel advice, along with a travel video.
Lessans also markets travel products, from voltage converters to her own line of high-powered insect repellent. "In the U.S., when you get a mosquito bite, you get a bump," she says. "In Africa, you could get malaria."
There are many other specialized service providers in the field. InHouse Physicians, for example, can provide on-site and on-call medical services in the form of physicians, nurses, paramedics, and specialists, and can provide a mobile pharmacy and staffed medical stations. IHP can assist with defining medical protocols and also offers a medical education services program that can prepare meeting staff with CPR, first aid, and Automatic External Defibrillator (AED) training.
Numerous other nonprofit and corporate resources are available to help meeting and incentive planners keep attendees healthy and safe. These include consultants, specialized clinics, and knowledgeable travel agency representatives who can speak from firsthand experience.
The bottom line: Learn everything you can and share as much knowledge as possible with attendees so that you can all make informed decisions.
Customize this tip sheet with specific destination information and mail to attendees (or potential attendees) at least four months prior to departure.
Before You Go * Plan to get recommended immunizations several months before departure; allow time for additional boosters if they are needed.
* Check to see if health insurance covers illness abroad; consider getting an emergency medical assistance insurance policy or a rider to a policy in force.
* Develop a plan for illness or disability. Have a plan for traveler's diarrhea that includes antibiotics, antimotility agents, and a fluid/electrolyte solution.
* Take adequate supplies of all required medications (including syringes, if needed) and written prescriptions.
* Take extra eyeglasses or lenses (and optical prescription).
* Pack protective clothing, hats, and sunglasses as appropriate. Use a layering technique to avoid cold exposure.
In Developing Countries * Eat at busy restaurants. Fast turnover and expert buyers and chefs lessen chances of exposure. Be wary of buffets--especially if you are eating late--and food sold by street vendors.
* Avoid raw shellfish, especially oysters, and items with lightly cooked eggs, milk, or mayonnaise. Be sure meat is well cooked.
* Drink bottled, boiled, or chemically treated water. (Beer, wine, and bottled beverages should be fine.) Avoid ice and use fresh straws and disposable cups if possible.
* Eat only fruits you peel yourself; avoid purchasing fruits and vegetables sold by weight.
* Don't walk barefoot. Ask about localized health risks associated with swimming, wading, or bathing in fresh waters.
* Use a scarf to cover your mouth and nose to forestall respiratory ailments (especially where there may be an abundance of bird droppings).
Health and Safety Resource Guide Centers for Disease Control and Prevention, Atlanta * Disease information (888) 232-3228
* International hot line with recorded information and fax-back service (404) 332-4559
* www.cdc.gov, lots of useful information and links
The American Society of Tropical Medicine and Hygiene * www.astmh.org
International Association for Medical Assistance to Travelers, Lewistown, N.Y. * www.sentex.net/~iamat
International Society of Travel Medicine * www.istm.org
InHouse Physicians Inc., Atlanta * phone (800) 356-3627
Passport Health, Baltimore * phone (888) 499-7277
Shoreland Travel Health Online * www.tripprep.com/index.html
U.S. Embassies * Contact the embassy in your destination country for information on English-speaking doctors or how to get reliable medications.
U.S. Department of State * Overseas Citizen's Services--to report emergencies or hear travel warnings, call (202) 647-5225
* Automated Fax Service, call (202) 647-3000 for consular information sheets and travel warnings
Bedside Reading The International Travel Health Guide (Travel Medicine Inc., 800/872-8633)
The Safe Travel Book by Peter Savage (Lexington Books; contact Passport Health, 888/499-7277)