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David R Shlim
As I read through TravelMed, the ISTM Listserv everyday (something that I encourage all members to do), I often have a number of thoughts. Initially, I'm pleased that we have created such an active forum for sharing knowledge about travel medicine. Then, I notice the wide range of approaches that members have adopted towards the practice of travel medicine. Some like the practice of travel medicine to fall into an algorithmic formula, with definitive answers for most situations. Others are more willing to push a situational approach, based on a number of variables. And yet others are unabashedly anecdotal, as in "this is what I've always done." Not frequently enough, someone contributes an authoritative opinion based on a review of the literature.
Often the same questions get asked over and over due to new members joining the Listserv, or older members not remembering or not having seen the previous questions. To address this issue, the ISTM has been working on a complete revision of how the Listserv will be presented, along with an ability to create forums, and search past postings. We will be rolling this out in the next couple of months in an easy-to-use format called myISTM.
In the meantime, we should take a moment to reflect on how we each approach travel medicine practice. Are we most comfortable following established guidelines in all cases? Do we deviate from guidelines for particular reasons? Where no set guidelines exist, how do we come up with our own? Is it more comfortable to recommend all possible vaccines or prophylaxis, or is it possible to try to fine-tune recommendations to the individual patient's sense of risk, knowing that we are a bit more vulnerable in that situation?
There was a time when we believed that if we just knew the epidemiology of diseases in travelers, we would know what to recommend. However, as our knowledge of disease risks has increased, our ability to make decisions based on those known risks has not gotten easier. Do we recommend immunization for a disease that has a risk of 1 per 1000, 1 per 100,000, or 1 per 1,000,000? Is there a difference between those three levels of risk? Does it depend on the seriousness of the disease? These are discussions that need to continue. I think that our perception of risk depends a lot on our own anecdotal experience, so we must remain alert to how that might affect our recommendations. For example, I saw hundreds of travelers with typhoid fever in Nepal, so I know that certain travelers are at risk. I've seen other experts stating that typhoid fever is now so rare that immunization is only rarely, if ever, indicated. When, exactly, should we be recommending typhoid fever immunization?
The two most troublesome vaccines to deal with are yellow fever vaccine and Japanese encephalitis vaccine. With yellow fever vaccine we have to weigh the risk of the vaccine against the risk of disease, and with Japanese encephalitis, we have to weigh the expense of the vaccine against the vanishingly low number of actual cases. However, I'm sure that if someone had a traveler who developed Japanese encephalitis on a trip, that practitioner would thereafter recommend JE vaccine much more frequently, despite the actual figures.
The Listserv, and the upcoming new forums, will be a great opportunity to try to explore some of these issues. I would urge members to consider doing their own background research. It is not difficult to become an expert in a particular area of travel medicine: just look up everything that has been written about it, review it critically, and help distill it for fellow members. One thing to be alert for is how often subsequent papers just cite previous review papers for risk figures and other data. The original paper that measured the risk may not even appear among the citations. For example, the figure that is most often used to express the risk of hepatitis B infection in travelers was calculated from a single paper that measured the risk in a group of African missionaries more than fifty years ago. Only in the last year or so has there been an attempt to measure the risk of hepatitis B in modern travelers.
We need to be diligent in questioning our colleagues and ourselves about our assumptions in travel medicine. It's a fascinating and constantly changing field, and we should approach it proactively, trying to always expand our range and depth of knowledge in a collaborative way. We have a lot we can learn by looking backwards, and not always thinking that the answers lie in some yet to be completed research. I look forward to a new generation of travel medicine practitioners who will search the literature for us, reminding us of where we've been, and how we know what we currently know.
David R. Shlim
From the Editor
Christopher Van Tilburg
Nigh on the eve of another adventure, I'm heading to where I'm most at home: the high alpine. Jackson Hole, Wyoming, USA, is the setting for next year's regional ISTM conference. The lush meadows, gurgling streams, and high peaks of the Grand Tetons will be juxtaposed with world renown academics in both Travel and Wilderness Medicine, kindred disciplines for global adventurers. It will be a blending of adventure, outdoor and travel medicine amongst the most spectacular mountains of the world.
Those of us who travel often, probably never really unpack. As I assemble my gear for the mountains, I'm packing my ubiquitous trail running gear and my travel essentials, the latter stashed in a small pouch. We all have things we never leave home without, no matter where we go or how long we leave.
My essentials include a headlamp for late night reading and early morning stumbling out of bed for coffee. Hand sanitizer, earplugs, and sunscreen in tiny packages. Water purification tablets--chlorine dioxide are my favorite because they come in small foil pouches and treat giardia. A roll of waterproof first aid tape is often the only medical gear I bring. A few essential meds: ibuprofen, acetaminophen, and azithromyicine. A photocopy of my passport and medical license.
Indeed, bigger trips, I take more gear but this small pouch goes with me everywhere.
What's in your travel essentials kit? Something you never leave home without? Send me an email for next issue of NewsShare.
Christopher Van Tilburg
ISTM NewsShare Editor
Peter A. Leggat
ISTM.org, the ISTM's window to the world, is about to migrate to a new state of the art professional society web platform. It is just one of the many changes members are will see in coming months. MyISTM, the ISTM member portal, will provide many convenient features to help members gain the most from their international society. I wish to applaud Christopher Van Tilburg for helping to champion improved communications with our members through the website as well as through ISTM NewsShare. It is great to see ISTM NewsShare downloadable as a PDF so that it can be printed for the clinic, tearoom or office or viewed on your phone or tablet.
In the meantime, the ISTM membership renewals will be sent out soon: you can conveniently renew on line. The many benefits of ISTM membership are listed on our website under "About ISTM". It is worthwhile for you to take a look at what members are eligible to receive, so that you don't miss out on opportunities. Please ensure that your clinic is listed correctly in the Global Travel Clinic Directory, which receives more than half a million hits per year. This is one of many important resources for travelers may need assistance. Other valuable resources and benefits, which are part of ISTM Membership, include the ISTM ListServ, TravelMed, the new rabies vaccine directory, the expert opinions and other initiatives, such as the bibliographies compiled by the professional groups.
It is important for all those involved in travel medicine to belong to a professional organisation. The ISTM is a must join professional organization, as it truly engages internationally in research through programs such as GeoSentinel, and through education and professional recognition through programs such as the Certificate in Travel HealthTM (CTH®). It is wonderful to see that well over 800 new members have already joined this year and we now have close to 3200 members. The addition of several new reduced fee categories of membership, including Retiree and Associate (for resource poor countries) memberships, reflects the ISTM's eagerness to reach out to as many people as possible interested in travel medicine. I urge every member to reach out and recruit new members in all parts of the world. Please pass on a membership brochure to a non-member colleague or encourage them to attend an ISTM conference.
There is certainly strength in numbers, but there is even more strength in participation in the activities and work of your society. For example, consider publishing in the Journal of Travel Medicine, or applying for an ISTM research grant, get discounted registration for CISTMs, and look out for the many other benefits for members, including listing in the Clinic Directory mentioned earlier. MyISTM will also be a quantum leap forward in helping to connect members to ISTM member benefits and I look forward to the official launch of the new website platform, which is coming very soon.
So renew your membership for 2014, promote your society to colleagues, take the time to engage with the active professional and interest groups and take advantage of the many other benefits that ISTM membership has to offer.
Peter A. Leggat
News from the Secretariat
Diane L. Nickolson
As Dr. Leggat mentioned in his Secretary-Treasurer's report, membership in ISTM comes with many valuable resources and benefits, including a variety of publications, discounts on products and programs as well as complimentary educational resources and tools. All of these resources can be accessed through the Member Services section of our website, www.ISTM.org.
Expert Opinions in Travel Medicine
The Professional and Education Committee (PEC) of ISTM produces travel medicine educational vignettes each year entitled "Expert Opinions." Expert Opinions presents a pre- or post-travel quandary that is answered by an invited ISTM member with expertise in the topic discussed. Once produced, the PEC encourages ISTM members to discuss additional aspects relating to the scenario on the ISTM TravelMed Listserv. These vignettes are offered free to ISTM members. Recent cases include the following:
- Advice on Dengue fever for an American student going to live two years in Asia - Poh Lian Lim, Singapore
- Advice to adolescent traveler for sports competition at high altitude - Christopher Van Tilburg, United States
- TBE Advice for Honeymooners travelling to southern Austria, Switzerland and Germany - Martin Haditsch, Austria and Germany
- Hepatitis A and B advice for a student travelling to India - Pierre van Damme, Belgium
- YF vaccination for a pregnant woman traveling to Ivory Coast - Dale Carroll, United States
- Malaria risk of a Swiss Traveler to Hong Kong, Thailand and India - Stephen Toovey, South Africa
Travel Medicine Teaching Slides
Available as a 158-slide PowerPoint presentation, the travel medicine teaching slides are suitable for lecturing to both healthcare professionals and lay groups. Slides are grouped by subject area (e.g., Risk Assessment, Vaccines, Malaria, Travellers' Diarrhea, Special Needs Travellers, Post-Travel Syndromes) for easy customization of lectures. Material and teaching points are international in scope, allowing the presenter to elaborate on specific local dosing and availability issues. There is a small fee to download the slides. The Teaching slides can be accessed through the ISTM site here.
The Responsible Traveler
In an effort to promote responsible and healthy travel, ISTM has made available free guidelines to our members for respectful behavior of travelers. The guidelines are available in various translations which were prepared by the ISTM Destination Communities Support Interest Group. More translations will be available in the future. ISTM Members can download the current documents by selecting them below:
- The Responsible Traveler in English
- The Responsible Traveler in French
- The Responsible Traveler in German
- The Responsible Traveler in Croatian
A shortened version in English is printed on an attractive, 7 x 20 cm (3 inch x 8 inch) card that makes for a handy bookmark, especially appropriate for use when reading travel guides. And as an added bonus, the flip side of the card has the 10 Tips for Healthy Travel. A supply of cards is available from the ISTM Secretariat. One hundred cards will be sent free of charge each year to any member requesting them. You may also purchase these should you wish to receive more than 100 cards. Click here to order.
Online Learning Program
In 2011, ISTM established an online distance learning program available through the internet. Individual sessions from the yearly Travel Medicine Update and Review Courses, as well as from the international Conference of the ISTM (CISTM) are accessible. Topics are relevant to all travel medicine practitioners, with both introductory and more advanced content. Individual sessions range from 30 minutes to four hours, and can be ordered individually, or with volume discounts. Sessions from the recent CISTM13 held in Maastricht, The Netherlands, will soon be available. Members receive a discount when purchasing the sessions, and are available for viewing at your convenience over the internet for six months after purchasing. For a list of available programs and more information click here. There are more than 60 sessions currently available.
Some of the many titles offered include:
- Dengue: Into the Future
- How to Start a Travel Clinic
- Malaria Prevention
- Principles of Immune Response, Including Modifications for Travel
- Psychological Health Issues in Long Term Travellers
- Special Populations: Business, Long-stay, and VFR
- The Pediatric Traveller
- Traveller's Diarrhea Prevention and Management
- Yellow Fever Risk
We hope that, as an ISTM member, you will make use of these and other resources as you care for and advise your traveling patients.
By renewing your membership each year, you will continue to participate in the TravelMed ListServ, receive valuable publications, and have access to a wealth of information available only to current ISTM members.
Diane L. Nickolson
ISTM Executive Director
Upcoming Conferences, 2014
The Wilderness Medical Society is excited to partner with our colleagues in the travel medicine community for our Annual Meeting in Jackson Hole, Wyoming, USA, August 2-6, 2014. There is great overlap between the provision of care in austere and extreme environments, and the provision of care in resource-poor or remote settings. There is much we can teach and learn from each other. WMS members are excited by the chance to explore some new topics, hear some new experts, and to explore beautiful Jackson Hole. We are confident that this will be a tremendous experience for members of both organizations. --Tracy Cushing, MD, WMS
In conjunction with the Wilderness Medical Society, ISTM will offer the Certificate of Knowledge Examination on Saturday, 2 August 2014. Open to all health care professionals, the Certificate recognizes individual excellence in knowledge of travel medicine. Click here for more information about the Certificate program and for future announcements concerning Exam registration and information
The 10th Asia Pacific Travel Health Conference will be hosted at the Caravelle Hotel in Ho Chi Minh City, 7 to 10 May 2014. Themed "Emerging Infections and Travel", the conference is organized by the Asia Pacific Travel Health Society with the support of the International Society of Travel Medicine, the Singapore Infectious Disease Society, Australasian College of Travel Medicine, Japanese Society of Travel Medicine, Japanese Society of Travel and Health, Thai Travel Medicine Society and the Maritime Health Association.
"Travel and tourism in Vietnam has seen record growth in recent years with rising household income, increased government spending on infrastructure such as airports and highways, and improved health and living standards. Ho Chi Minh City will be an extraordinary venue in which to learn, discuss, exchange and share knowledge and experiences among colleagues for the advancement of travel medicine in the region," said Dr. Sarah Borwein, President of ATPHS.
"We invite our colleagues to take part in this important scientific gathering and submit abstracts of your latest research work. A commercial exhibition and networking events featuring the best of Vietnamese cuisine, culture, and hospitality will make your participation at APTHC 2014 a truly unforgettable experience," she added.
The ISTM Certificate in Travel Health© will be administered on 7 May at Caravelle Hotel. For conference details, visit www.apthc2014.org or call +65 62924710. To register for the CTH, visit www.istm.org. -Malou Guevarra, APSTM
The Northern European Conference on Travel Medicine (NECTM) will be held in Bergen, Norway, on 5-8 June 2014. The NECTM was founded in November 2003 by Travel Medicine Society of Ireland and British Travel and Health Association, Health Protection Scotland, Royal College of Nursing and National Travel Health Network & Centre in the United Kingdom, and by the Danish, Finnish, Norwegian and Swedish travel medicine societies. Since then the travel medicine societies in Germany and the Netherlands have joined.
The 1st NECTM was held in Edinburgh in May 2006 in collaboration with ISTM as a regional conference. Since then, conferences have been Helsinki (2008), Hamburg (2010) and Dublin (2012) with 800 - 1000 participants.
Apart from main travel medicine topics treated, each particular NECTM has its own focus. In Bergen experience from Nordic travel, cold climate and occupational health will be covered. A pre-conference tour will be "Norway in a Nutshell." Our motto "within walking distance" points to the fact that all in-conference facilities will be reached easily by foot and Bergen as destination is reasonably close. More info on www.nectem.com. -- PÃ¥l Voltersvik, Chair
The South African Society of Travel Medicine will be hosting a conference with the above theme in Durban, South Africa, from 18-21 September in 2014 in conjuction with ISTM. Africa is developing rapidly with greater business investment and increasing trade to this continent. Increased travel will result, both from a corporate and a tourist perspective, which will bring its own challenges. The theme of the Congress, QUO VADIS?, will focus on the implications for the corporate world, the expatriate community and the emerging diseases that pose a threat not only to the traveler's destination country but also the country of origin. Presentations will be in the format of scientific symposia, workshops, travel scenarios, risk assessment and poster sessions
The venue is the Elangeni Hotel, which is situated on Durban's Golden Mile, two hundred metres from the beach and the warm waters of the Indian Ocean. For more info, sastm.org.za. -Garth Brink, chair.
16th International Congress on Infectious Diseases, Cape Town, South Africa, 2-5 April 2014
The website is now available for the 16th International Congress on Infectious Diseases planned for Cape Town, South Africa on April 2-5, 2014 /www.isid.org/icid/ . You will find the latest updates on the exciting 16th ICID scientific program encompassing all fields in infectious diseases with particular attention being paid to the major infectious causes of death in Africa and elsewhere. Abstract submission instructions www.isid.org/icid/abstract_guidelines.shtml and complete hotel and registration information www.isid.org/icid/registration_guide.shtml is also posted.
Please note the following important deadlines:
- Abstract submission deadline: December 2, 2013
- Early registration fee deadline: February 3, 2014
The meeting will be held in beautiful Cape Town, where the Atlantic and Indian Oceans meet at Cape Point, home to Table Mountain, and gateway to the Cape Winelands and the interior game parks of Southern Africa.
Plans for CISTM14 Underway
With a fantastic array of sessions, meetings and special events, over 1200 attendees, and the beauty of The Netherlands and Maastricht still fresh in our minds, it is already time to turn toward Québec City, Canada, and the plans for CISTM14. The ISTM Executive Board has appointed five Chairs for the CISTM14 Scientific Program Committee (SPC). They are:
Leo G. Visser
Lin H. Chen
SPC Associate Chair
United States of America
SPC Associate Chair
SPC Associate Chair
The SPC Chairs will implement the Call for Proposals in October, inviting all members of the ISTM to consider submitting symposium and workshop ideas to review. You will be able to access the submission form directly on the ISTM website at www.ISTM.org. ISTM members are encouraged to submit proposals for plenary, symposia, and workshop sessions for review by the SPC. A notice will be sent out to all members once the proposal website area is active. Submissions will be accepted through 15 March 2014.
As the planning progresses, we look forward to another outstanding CISTM program - a program that will be possible only with your ideas and suggested topics. Only through broad participation can we plan a meeting that effectively serves the interests and needs of all members of ISTM and the world-wide travel medicine community. We look forward to seeing you in Québec City in 2015!
Professional Education Committee
The Professional Education Committee (PEC) is pleased to announce the results of the Rabies Vaccine, Rabies Immune globulin, and Japanese Encephalitis Vaccine product availability survey that was sent out several months ago. These results have been formulated into a document now posted on the ISTM website, organized by country, making it easy to see what the product availability is for the particular destination, for example, finding a location for a patient to complete a rabies vaccine series or obtain RIG. This should eliminate the need for anyone to post a query to the entire Listserv asking for this kind of information. The information will be available on the main ISTM website page.
ISTM PEC Chair
News from the Nursing Professional Group (NPG)
NPG Elections 2013
Later this month all NPG members will be sent a slate of candidates for four open positions on the NPG Council. Please confirm that you are an NPG member now so you can cast a ballot.
Article Just Released
In the July-August issue of Travel Medicine and Infectious Disease, Irmgard Bauer, Sheila Hall, and Nahoko Sato published the results of a survey of 474 travel health nurses. Their analysis highlights international differences and similarities on a number of professional issues, including work arrangements, educational needs, clinical practice challenges, and practical concerns. The article makes for very interesting and worthwhile reading! NPG thanks these nurses for their hard work and contribution to the travel health- and nursing- literature. (Bauer I, Hall S, Sato N. Providing travel health care - the nurses' role: An international comparison. Travel Med Infect Dis. 2013 Jul-Aug;11(4):214-24.
NPG members attend World's Largest International Meeting for Nurses in Melbourne
By Cindy Rugsten and Lani Ramsey
Lani Ramsey and Cindy Rugsten
The International Council of Nurses (ICN) held its 25th quadrennial congress in Melbourne, Australia in May. Approximately 4000 delegates, the world's largest meeting for nurses, from over 120 countries attended this five day meeting. Two ISTM NPG Council members, Lani Ramsay and Cindy Rugsten, attended. They attended as volunteers of the congress and participated in congress organization, registration, greeting delegates, and manning the first aid station. The meeting broadly addressed issues in global nursing policy, equity and access issues, and future trends in nursing.
The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations (NNAs), representing the more than 16 million nurses worldwide. Founded in 1899, ICN is the world's first and widest reaching international organization for health professionals. ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. Travel Medicine Nursing was not formally presented or represented at the 2013 congress. Travel Medicine Nursing is not yet recognized as a sub-specialty within ICN. Lani and Cindy were able to do some networking while carrying out their congress volunteer duties and were able to share information about ISTM and NPG with individual nurses. After attending this meeting, Lani and Cindy agree that ISTM should consider formal representation at future ICN events given this is the world's largest and most far-reaching gathering of nurses.
ISTM NPG Chair
Destination Communities Support Interest Group (DCSIG)
Many of us at the grassroots level of travel health care should be familiar with the ever increasing popularity of "voluntourism:" such as a student on a gap year, the recently retired traveler working or volunteering overseas, and the luxury safari traveler who adds in a volunteering option. All of the above will be travelling with the best of intentions, but it is perhaps worthwhile reflecting on the affect that this type of travel can have on the indigenous communities. Volunteer and charity programs are often well organized but often include a commercial side with large tour operators now offering the "volunteer experience."
Within the ISTM, our Destination Communities' Special Interest Group (DCSIG) is keen to network with members to hear of their thoughts on volunteering experiences. Currently, some agencies are developing codes of conduct for travel companies and volunteers. The following web sites will provide you with some background into the dilemmas of volunteering: www.learningservice.info, www.comhlamh.org
Please contact us with your thoughts, opinions and experiences - good or bad!
ISTM DCSIG Chair
Christopher Van Tilburg
Traveler's Health: How to Stay Healthy Abroad, 5th ed, by Richard Dawood (Oxford, 2012) is designed for our patients. Jam packed with information, this somewhat compact book is a good reference for patient to keep at home but probably too bulky for a weight and space conscious traveler. In addition to infectious disease, it contains complete travel information on a huge range of subjects, including recreational hazards like water and snow sports, working abroad, medical kits, and special populations like children, elderly and armed forces.
Christopher Van Tilburg
ISTM NewsShare Editor
NewsShare Travel Talk: from the ListServ: Mefloquine Toxicity
The Topic: Recent FDA boxed warning added to mefloquine label about neurologic and psychiatric side effects that can persist for months or years after discontinuing drug
The Talk: A technicolor discussion ensued about this topic. A number of practitioners reported seeing few side effects with mefloquine. Mefloquine was favored because of doxycycline side effects and the high cost of malarone. There were a few suggestions to ameliorate side effects such as changing the dosage regimen to 1/2 tablet twice weekly, 1 tablet daily for 2 days then weekly; decreasing the dose in women who are more susceptible to side effects, and decreasing the dose in lower weight patients. Other suggestions included avoiding mefloquine in older patients, premenopausal women, and teenagers. A number of people agreed that the stress, fatigue and insomnia of travel, alcohol, and recreational drugs can unmask preexisting or precipitate psychiatric illness. A US practitioner worried about getting sued since there is an enhanced warning and there are already ads on the internet. Another practitioner has travelers sign an acknowledgement of risks.
Practioners recommend a detailed mental health history and counseling travelers carefully about potential side effects.
ISTM NewsShare Deputy Editor
Chat with the Expert:
ISTM President-Elect, Prof. Dr. Annelies Wilder-Smith
Dr. Annelies Wilder-Smith is President-Elect of ISTM. Dr. Debra Stoner caught up with her for some insight on Dr. Wilder-Smith's upcoming leadership role.
What personal skills will you find most helpful as you prepare for your ISTM president tenure? Good communication skills are most important. Listening to members is paramount to develop a sense of direction for the ISTM, especially the various interest groups that are currently shaping the ISTM.
What was your favorite book, of the many you have published? "Travel Medicine: Tales Behind the Science," is not a purely scientific book, but rather a collection of stories, histories, anecdotes, personal experiences, and some dreams into our future. I believe that the best lessons are learned from personal stories and behind every piece of research in travel medicine, there are stories that remain untold in the scientific literature.You are an internationally recognized expert in dengue, what advances in prevention lie on the horizon? I have the privilege of collaborating with 14 partners around the world through a grant funded by the European Commission www.denguetools.net. For more than three decades we have tried to develop a dengue vaccine, however early efficacy trials have shown a lack of good clinical protection. The development of a dengue vaccine is more challenging than we all anticipated. Yet, we are desperate to have a vaccine soon, in particular for the endemic population but increasingly also for the travelers.
What is the biggest challenge facing the Travel Medicine profession? Being still a relatively small society, the biggest challenge is being pulled into different directions and different vested interests, given the fact that the field is so broad.
ISTM NewsShare Deputy Editor
'Thank you' Notes
[The following letters were received from one of the recipients of the funds donated through attendees at the recent CISTM13.]
15 July 2013
To everyone at ISTM
Thank you for your very kind donation to the Australian Himalayan Foundation!
We are very grateful for your generosity and support of our work which will enable us to continue delivering our education, health and environmental projects across Nepal, Bhutan and India. Over the years, thousands of people have visited the Himalaya. For many it is an opportunity to trek beneath the world's highest peaks and to appreciate some of the world's most hospitable cultures. Yet the Himalaya is not just a vast adventure playground. For the local communities it is anything but easy - with access to basic health and education services often out of reach.
Following in the footsteps of Sir Edmund Hillary, the Australian Himalayan Foundation is working to help the people of the Himalaya through improvements in health, education and conservation in Nepal, India and Bhutan. We work in partnership with local communities to help the people of the Himalaya achieve their goals in a long term, sustainable way.
None of our project developments could have happened without the assistance of loyal supporters like you. We value your commitment to improving the lives of the people of the Himalaya.
Dear International Society of Travel Medicine Executive Board and Council,
The Chad Relief Foundation acknowledges with gratitude the generous donation of the International Society of Travel Medicine (ISTM) to its efforts to assist the Central African Republic refugees in south Chad through ISTM's 2013 Charity Donation program. Chad Relief Foundation funds projects in education, health and recreation in five UNHCR refugee camps and the contribution of the ISTM will make a significant difference in the lives of many of these forgotten people.
Very best wishes,
President, Chad Relief Foundation