Emporiatrics Versus Geographic Medicine: Interface or Spectrum?

Abstract

Specialization is an inevitable byproduct of medical progress. Geographic Medicine and more recently Travel Medicine (Emporiatrics) are the result of rapidly expanding technology and information. Geographic Medicine deals with the health of “natives” emporiatrics with the concerns of“travelers.”Traveler and native are perceived as separate monolithic elements, each exposed to its own diseases. In general, the extent and severity of disease, and ultimately the requirement for medical intervention, are seen to parallel the ongoing exposure and deficient health care of the native.As such, the tourist enjoys a brief, protected environment, sheltered from the larger “unhealthy” ecoloby of a surrounding countryside. Thus, the literature of the World Health Organization and other official bodies reports disease incidence among natives; publications in Travel Medicine deal with the seemingly unrelated risk for that same disease among travelers. The obvious question is, “What is a tourist, and what is a native?”The Peruvian “native” is a subsistence farmer living at the jungle’s edge or a hotelier in Lima, while the tourist is a middle-aged client of that hotelier or a 25-year-old niountaineer passing through that same jungle.While the health risks of the mountaineer exceed those of the others, he or she is semantically a “tourist,” and the responsibility of the Travel Medicine specialist. In fact, the health risk of“tourist”and “native”vary considerably and tend to overlap (seeTable 1).As exposure increases, the health risks of tourists approach, and even exceed, those of natives. The health of interniediate groups (students, expatriates, immigrants, military personnel) could be seen as problems in Geographic Medicine or Emporiatrics.The difference is lost on nonexpert physicians, who must deal with the “exotic” disease exposure of immigrant and tourist alike. The major differences between the “typical” native and tourist are quantitative rather than qualitative, and they contrast such variables as wealth, local geography, access to health care, etc.These differences are magnified in space and time. New diseases, outbreaks, drugs, diagnostic tests, and vaccines color the dynamic of season, geopolitical upheaval, health care economics, and many other factors that impact on the needs of tourist and indigent alike. Financial constraints also affect health experts, thereby limiting their role in treatment (Geographic Medicine) when prevention (Travel Medicine) is perceived as a luxury. Specialists in “Geographic Medicine” and “Tourist Medicine” both overlap and complement each other; their continued separation is artificial and myopic. Indeed, any differences may reflect the economic and academic environments of health practitioners themselves, rather than their expertise. As such, combining these two fields (joint meetings, journals, specialty boards, etc.) could encourage despecialization to “International (or Global) Medicine.”