Missionary Airfare Search Update on European Air Travel

The following is an email we received from Lufthansa of the Star Alliance late Friday afternoon. PLEASE NOTE: On travels to Africa we will attempt to use South African Airways and Ethiopian Airways in order to by-pass Europe entirely! These flights will fill quickly, so place something on a courtesy hold right away!

As this is sent on April 19th, Monday afternoon, there are encouraging signs of air service beginning again. If you have a departure, please check the airline web site for up to date information.

Volcanic eruption causes irregularities in flight operations

Last update: 16th April, 1700 UTC Please read the latest updates on the flight status here on this page.

Like all airlines, Lufthansa must comply with directives issued by ministries and air traffic control. Many European airports have closed. In Germany, the airports in Berlin, Bremen, Cologne, Dortmund, Dresden, Dusseldorf, Frankfurt, Hamburg, Hanover, Hof, Leipzig, Munich, Muenster/Osnabrueck, Nuremberg and Stuttgart have shut down. All arrivals and departures at these airports have been cancelled until further notice.

Passengers who have booked flights from the above-mentioned airports are requested not to travel to the airport and to keep up-to-date with the status of their flights via electronic media.

Passengers travelling within Germany can switch to a journey by rail with Deutsche Bahn, if their flights have to be cancelled. For that purpose, they must exchange their electronic ticket (etix) for a travel voucher at a Lufthansa check-in machine at the airport. Alternatively passenger can buy a Deutschen Bahn AG rail ticket. In this case the flight ticket price can later be refunded*.

Passengers whose flights have been cancelled will be rebooked in the same compartment free of charge on other flights (which must be flown by 31 May). Alternatively, if they wish to cancel their ticket, they will receive a refund. Further information is available from the Lufthansa Service Center or out of Germany toll free under 0800 8 50 60 70. Due to the exceptional circumstances, customers may face longer than normal waiting times.  At present it is not possible to predict how the air traffic situation in Europe will progress.

* non-flown tickets will be fully refunded. Partly flown tickets will be refunded pro-rata.
Blessings,
Blake Stiles Lawson, Founder
reservations@missionaryairfaresearch.com
877.634.1199
770.436.1334
770.928.2659 Fax

JET LAG and the United Methodist Volunteer

Jet lag is one of the most common problems confronting the world traveler, and our mission volunteers are certainly not immune. Though not life threatening, this disturbance of the sleep cycle can seriously interfere with our ability to function at full capacity. We often need to hit the ground running, take on major responsibility, make critical decisions and work long hours under difficult conditions. We do not usually have the luxury of spending several days recuperating from a jet lag caused hangover, so it becomes important to consider the cause and possible ways to lessen its severity.

Jet lag is a sleep disorder that results from crossing time zones too rapidly for our circadian clock to keep pace. This clock, located in the brain’s hypothalamus, regulates alertness during the day, and sleepiness at night, in response to alternating patterns of light and dark In addition to setting time for sleeping and waking, circadian rhythms also dictate times for eating and some hormone regulation. Of interest, the severity of jet lag is not related to the length of the flight, but to the number of time zones crossed. It is also worse when traveling from the West to the East than in the reverse direction. If traveling in a North South direction, you may get tired and sleep deprived, but do not get jet lag. Some of the symptoms resulting from jet lag can be insomnia, sleepiness during the day, dysphoria, and most importantly, diminished physical performance and even cognitive impairment. There is a wide person-to-person variation in severity and specific type of effect following a given disturbance of the light dark cycle.

Many treatment strategies have been recommended for jet lag, some with more evidence of effectiveness than others. A recent review (1), recommends three approaches:

1. Promoting a realignment of the body’s circadian clock by using an appropriately timed exposure to light and the administration of melatonin,

2. Planning an optimal timing and duration of sleep

3. Using medication to counteract the symptoms of insomnia and/or daytime sleepiness.

You can readjust your circadian clock by exposing yourself to bright sunlight or strong artificial light, in the morning after eastward travel and in the afternoon after traveling to the west. Also plan to stay in the dark or in subdued light for the first few hours of daylight after long eastward fights or a few hours in the afternoon after long flights heading west. Two or three days of such a regimen should be sufficient.

Melatonin is a hormone secreted by the body during nighttime hours that has an effect on circadian rhythm opposite to that of sunlight. The ideal dose and timing of administration have not been clearly established, but it is commonly taken in a dose of 0.5 to 3mg at bedtime after arrival at your destination. It is available as a nutritional supplement in a 3mg tablet.

Plan a strategic sleep schedule prior to the trip, gradually shifting by 1-2 hour increments toward matching the projected schedule at your destination.. Flying first or business class usually means more restful sleep, as does eating sparingly and avoiding alcohol. Hypnotic agents can be used to counteract insomnia caused by jet lag. Short acting agents such as Ambien or Lunesta in modest doses are recommended to avoid next day sleepiness. The use of such agents during actual travel may be more problematic, unless the flight is of very long duration. Caffeine in moderate amounts may be useful to counteract daytime sleepiness, but taken late in the day may interfere with sleep. A relatively new agent, Nuvigil (Armodafinil), has been used to promote wakefulness in patients with narcolepsy and other conditions that cause daytime sleepiness. It is not currently FDA approved for use with jet lag, but showed promise in a recent study to promote wakefulness in patients with day sleepiness associated with jet lag.

In his review (1), Sack points out that much more research is needed to more completely uncover the causes of jet lag, and to determine the most effective treatment measures. I recommend reading this article if you want to learn more about this fascinating and troubling condition.

(!) Sack, R.L. Jet Lag: NEJM 2010;362; 440-47.

Roger Boe MD

Meningococcal Vaccine:

 Does Our Risk for Meningococcal Disease Warrant Routine Immunization?

Meningococcal disease is devastating, both in the form of meningitis, and in the less common but more deadly infection of the blood stream, (septicemia) and septic shock. Periodic outbreaks have occurred in the US, particularly among college students and military recruits. The main concern for us as short-term volunteers is its presence in both endemic and epidemic form in the so-called meningitis belt of Sub-Saharan Africa, (See map), and in parts of Asia.

Over 500,000 cases occur each year worldwide, and over 50,000 deaths. Although easily treated with high dose penicillin or chloremphenicol, the disease has a 10-15% mortality rate and a 20% incidence of significant neurologic residual. Young children and adolescents are at the highest risk, particularly after prolonged exposure under crowded conditions, such as in schools and military camps. Interestingly, adults over the age of 50 are much less susceptible. The largest recorded epidemic occurred in the African meningitis belt in 1996, with 250,000 cases and 25,000 deaths.

Meningococcal disease is predominantly caused by 5 serogroups, which somewhat complicates the vaccine picture. Type A and type C cause most of the disease in Sub Saharan Africa and Asia. Type B causes most of the disease in the US and Europe. Two types of vaccine are currently available, the polysaccharide, which has been in use for 30 years, and the new highly preferable conjugate vaccine. The conjugate quadrivalent vaccine, MCV4, is 90-95% protective after a single dose. The duration of protection is not known, but is at least 3 years.

The major question is: Does our risk of acquiring meningococcal disease warrant routine immunization? According to the CDC current recommendations:

• Vaccination is recommended for persons who travel to epidemic areas either during outbreaks or if contact with the local population will be prolonged

• Vaccination is advised for persons traveling to the meningitis belt of Africa during the dry season (December through June).

• Quadrivalent conjugate vaccine (MCV4) is currently indicated for persons 2-55 years of age.

• For further details on dosage and indications for administration, refer to cdc.gov/travel.

Ref: Wilder-Smith, A; Meningococcal Vaccines: A Neglected Topic in Travel Medicine? Expert Reviews of Vaccines. 2009; 8:1343-50.
Roger Boe MD

Methods to Prepare Surgical Teams Going Overseas

Globalization and technology have made the world we live in a much smaller place. It’s not that difficult to visualize a different country for every meal of the day, what with the rapid advances being made in the fields of technology and communication. The shortage of a resource in one nation thus allows us to import or borrow it from another, and when the need is medical in nature, more care should be taken in selecting the best possible alternative because lives are at stake. When surgical teams prepare to go overseas, here’s how they need to prepare:

· Be skilled at their job: Although this would seem a no-brainer and should go without saying, it has to be said. You may be skilled, but the important thing is to be skilled enough to find acceptance according to the standards of the host country. The best way to do this is to familiarize the team with the way things are done overseas so that they’re up to scratch and not found wanting when they arrive.
· Be aware of the medical standards in the host country: This is especially important if they’re going to a more developed country that has more stringent standards. The team may be brought in for its expertise or to cover for local lack of talent, but it’s still necessary to be aware of how things are done in the host country.
· Be aware of hospital policies: Every country has its own way of setting rules and enforcing them. There are various policies in a medical facility, some of which are written and others that are not. It’s important to be aware of them, to know pecking orders and socialization dos and don’ts. It helps avoid awkward and potentially embarrassing situations.
· Be aware of ethical considerations: There are issues that could have legal consequences if you’re not careful. What may be legit and lawful in your homeland may be punishable under the laws of your host country, which is why you need to be aware of what’s accepted and what’s not before you begin your work overseas.
· Learn the local language: Yes, there may be a common tongue like English, but it’s best to learn at least a few words and phrases that are commonly used in the vernacular (of the country they’re visiting) so that precious time is not wasted during emergency procedures and surgeries.
By-line:
This article is written by Kat Sanders, who regularly blogs on the topic of online surgical technologist schools at her blog iScrub. She welcomes your comments and questions at her email address: katsanders25@gmail.com

UMVIM Health Team Travel Arrangements

When health team leaders prepare for travel there are many issues to consider. For example, what is the most economical way to get volunteers to the intended destination with the necessary supplies? Some questions that frequently arise may be:
1. Which is best? Airline Group travel resources facilitated by the team leader OR Use of a travel agency with mission team experience?
If you are a team leader that has a preferrred method of arranging for health team travel, please post a comment at the end of this posting. I have used both of the above methods and both work well. For me, the advantage of using a reliable agency is that it reduces the amount of phone time and search for flights that occurs when the team leader deals directly with airline group travel desks. Pricing using either method seems to be somewhat comparable. Additionally, agencies are usually up to date on new airline rules regarding baggage and pricing and are able to make last minute ticket changes that are sometimes required.

Mission related travel agencies:
1. Janet and Kurt Kaiser, former Western Jurisdiction UMVIM Coordinators, arrange UMVIM trips. They are particularly involved in trips to Nepal and surrounding areas. E-mail is love2trvl@imbris.com

2. Educational Opportunities, Gordon Moody-Travel Agent. Email: eo@travelwithus.com or website: http://www.eo.travelwithus.com/

3. Blake Stiles Lawson at Missionary Airfare Search. E-mail: reservations@missionaryairfaresearch.com


2. What will the impact of checked baggage rules have on a team's ability to transport supplies? Because of complex and changing rules, go to the airline website before travel.
At this time, the airlines, listed below have published the following baggage rules for economy class:
South, Central America, Carribean, Bahamas & Mexico - Delta and United:
Allows each traveler 2 checked bags of up to 50 lbs, and a total of 62 linear inches each plus a personal item and a carry-on for international travelers at no additional charge.

South, Central America, Carribean, Bahamas & Mexico - Continental:
Tickets purchased before 5/8/08 same as above for Delta and United.
Tickets purchased after 5/89/08: First 50 lb, 62 linear inch maximum bag is free and second one costs $25.

Brazil - Delta, United and Continental: Two checked bags of up to 70 lbs. each.

All other International destinations for United: Two 50 lb. bags are allowed. For travel within Asia all checked bags must equal no more than 44 lbs.

Japan - Delta: Two bags, 70 lbs each are allowed.
Middle East, Africa, Europe - Delta: Two bags, 50 lbs. each

Europe, Micronesia, Middle East, Asia and Tokyo, through Houston and Rio or Sao Paulo - Continental: Two bags, 70 lbs. each

Tokyo, through Newark and Rio, or Sao Paulo - Continental: Three bags, 70 lbs. each.

Happy planning for your next volunteer trip!

"Mission Prescription" in Zimbabwe and Liberia

Wednesday, February 4, 2009
Julie Warren, an OB Nurse from Texas Conference is documenting her experiences as a health volunteer in her blog, which may be accessed in its entirety by going to the link "Mission Prescription" in the left hand column of this blog. Here is her most recent entry.
Johannesburg, South Africa
After a smooth, flight DFW to Washington DC, to Johannesburg. I am sitting here tired and catching up on the blog. In a couple of hours I will be flying onto Harare, Zimbabwe. I met Greg Jenks of ZOE Ministry in Washington and we have made a new friend a retired Zimbabwean pastor who is returning home to see how he can influence his country and the disaster it is in. He is obviously heartbroken. I have caught up on my travel email that Dana contacts me at - and I know my family are a little worried and missing me...but this will be a great adventure with many things to bring back and share with the Church that hopefully will open eyes and help the way we do things. Right now though I am praying that God will keep us all safe and put us to good purpose. Please pray for us and the work we will do. Pray that God will open our eyes and our ears to listen and our hearts to love those we meet on this journey
Posted by Julie at 6:59 AM 0 comments