Dr Akiko Nomura: Welcome everyone to the Return to Travel Session. It is an honour to be here with you at the UW C Forum learning to shape the future. My name is Dr. Akiko Nomura. I'm the Regional Medical Director based in Singapore for International S.O.S. With travel slowly resuming today, I would like to talk about how best to manage the health and safety of your students and also the teachers.

When they travel. Being a UWC parent myself, I cannot wait until my son can go on his project week trip in grade 11 Maybe some of you are hoping your Grade nine student will be able to go on their first choice trip to Australia or Kenya. Others may be prepping for their students to go on their adventures at Pulau, Cebu or Tillman, or maybe even the Singapore Zoo.

In this short segment, I will talk about how your students have always been supported during their trips. Even before COVID, there was a lot being done in the latter half. I will focus on what changed during COVID and how technology can help in future preparation for these school trips. So first off, let's talk about this case, which happened in Pulau Cebu a few years back, pre-COVID.

So this was a ten year old student who suffered from a knee injury with some superficial wounds after falling from height. The case started when the leader and the nurse called into International S.O.S. to speak to our duty doctor. Subsequently, they sent him some photos, so our doctor had visual information from the photos and also heard the medical history from the school nurse.

Our doctor decided that the wounds were treatable on site by the school nurse with the equipment they had, and pictures were taken every day by the school nurse sent in to International S.O.S. to ensure that the student's condition and the injuries were fine. And this continued until the last day of the trip. All the while, we were making positive contact with the school duty manager, and I'm pretty sure the duty manager was updating the parents as well.

This is a case in which, yes, there was an injury but with the equipment and the nurse available on site and also some medical advice from international S.O.S. The student was able to complete his trip with minimal disruption So this next case was a bit trickier for us. Again, it's a pre COVID case happened in Nepal, and the patient was a 17 year old student who had a past medical history of severe allergic reactions, but did not travel with her EpiPen.

She was a grade 11 student on a project week trip, meaning that she was travelling with about four of her classmates. But no parents, no teachers. So while in a restaurant in Kathmandu having her meal, she developed an anaphylactic reaction most likely to the peanut oil in her food and was brought to the emergency room of an international S.O.S. Network hospital.

The case started when a quick acting friend called in to international S.O.S., spoke to our duty doctor and provided some vital information about the student's case. She was having issues breathing. She was getting Puffier and puffier, and she was also developing a skin reaction. So upon hearing all this our duty doctor advised to quickly take a taxi to the hospital.

This was because having an ambulance depart the hospital, we threw the traffic pick the patient up again. We've through the traffic to go back to the hospital. It was going to take a lot of time and hailing a taxi. At that point, we're still safe and much quicker. We also called the hospital while they were travelling in the taxi to inform them that there was a particular student coming.

We provided the medical information available to us, so the hospital had prior medical information on the student. And also we put in a strong request to admit the patient. This is because on the day of your anaphylactic shock, you do have the risk of a recurrence. And we didn't want the student who was not travelling with any adults to lack any supervision during the first night.

So at least if she were admitted, she had the medical supervision of the hospital staff. So she was admitted and overnight she felt a lot better. She looked a lot better as well and was breathing normally. Now, the case got trickier from here because the group was travelling to Pokhara the next day. So they were going to depart from the capital, Kathmandu, and go to a smaller city.

Now, in any country, the capital and the bigger cities would have the better medical facilities. And because this student had just had a new anaphylactic reaction and was prone to the triggers surrounding her, she was at a risk for developing a second or third reaction. We didn't want her to go to a smaller city. So at this point we provided the school with some options.

One option was for her to remain in Kathmandu while her classmates travelled in a hotel near the hospital. So at least if there were a recurrence she could go to the hospital quickly. The other option, which was our recommended option, was to curtail her trip and medically escort her back to Singapore, where her usual doctor resides and also her parents were.

So the stakeholders agreed that it wouldn't really make sense to leave a 17 year old alone in a hotel in Kathmandu. So the decision was made to escort her back to Singapore. The next day we dispatched our medical escort. This medical escort arrived in Kathmandu, pick the patient up in the hospital and brought her back safely. Medically, supervised to Changi Airport, where she was handed over to her parents.

So this is a case in which, yes, there was a severe reaction to the local food. But with the quick acting friend and also the support of international SARS, the student was able to get the care that she needed in the first 24 hours. And then also the school was able to get firsthand information about her medical care and was able to make the right decision to bring the patient back So how does International S.O.S. provide this type of service?

We have 27 assistance centres around the world. This is where the leaders or the school nurses or the quick acting friends or the students themselves can call in on a 20 47 basis to speak to one of our doctors for medical advice. We speak 99 languages. So even if you're in a remote part of Nepal, and the hospital staff doesn't speak your language, we may be able to help out with our staff's language capabilities.

We have a total of 10,000 employees and about half of them are medical professionals. I'm one of them. You could be a doctor or nurse or paramedic EC pharmacist, clinical psychologist at International SARS. And we have about 90,000 providers around the world. To provide services to our members. So that network hospital that I mentioned in that last case is one of the 90,000 providers that we activate when one of our members needs the assistance.

So I usually I'm in Singapore, but I also have a role in our Bangkok Assistance Center and also our Manila Assistance Center. So you can say that I am aware a lot of times about the cases that are happening in Southeast Asia So at International S.O.S., we are seeing that businesses are resuming business travel pretty quickly. International travel is increasing by 10% every month, and domestic travel we are seeing increasing by 13% every month.

And I have to confirms that they predict in 20, 22 travel will resume to 75% of pre-pandemic volumes. One of our schools in Thailand has already resumed domestic travel and hopefully with the borders opening up schools in Singapore as well will resume travel soon So is your student ready for travel? We've taken the acronym Safe Trip to highlight what's important to look out for now and after the pandemic before you travel.

So as is four subject is your student healthy? Does he or she have any chronic disease that we need to be careful about vaccinations? We shouldn't forget that COVID 19 isn't the only vaccination in the world. There's also measles, polio, seasonal influenza and maybe hepatitis A if you're travelling to a certain part of the world, or yellow fever if you're going to that type of country.

So make sure that your students vaccination records are updated and relevant to the country. They're going to any other risk factors that they may have. Do they have a mental condition or are they vulnerable in any other way? So it's good to note all of this. So the A four assistance, this may be more applicable to the older kids who are travelling without adult supervision.

Do they know how to activate the medical assistance company like us, or do they know about the logistics surrounding their environment? Language issues Is there a language barrier and can they overcome those s. Is for fitness to travel so any healthy being needs to ensure that they are at their healthiest before travelling. Maybe you need to go for a medical checkup before you travel.

If you have a chronic condition, is your chronic condition controlled and at its best. You don't want to travel when your chronic condition is flaring up. Medications. Do you have enough medications for your entire trip? If your trip is one week you want to take ten days worth of medications. If your trip is one month, you want to take perhaps six weeks worth of medications.

This is because there might be airport closures or bad weather or maybe a change of plans and you don't want to scramble in a foreign country for your regular medications. So you want to ask your regular doctor for some extra medication that you can take a long for that peace of mind in case your travel gets extended. Medical Note.

It is always smart to have a medical note in English from your doctor stating what conditions you have and why you're taking this medication.

Some countries at the immigration, they will be quite strict with bringing in certain types of medications. So it will help to have this medical note to display to the officers that you're not bringing in this medication for illegal purposes and it's just for your personal use e is for environment. You want to make sure that wherever you're going, the environment is suitable for your purposes.

So accommodation does your accommodation have air conditioning? Does your accommodation have proper security? Your transportation? Are you going to take public transportation? And does that pose any risks? Are you going to be taking a private car And is that a trustworthy provider that you've activated if you're engaging in any activities? Have you you know, researched the activity and the company with which you are performing that activity So within a safe trip, I think the trip part has a lot more Red Fund.

The Red Fund I've highlighted the parts that have changed with COVID. So let's start with tea for tests. I don't recall pre-COVID having any pre-departure tests, or at least not in an organised fashion. But these days, it is the reality that we get tested for travel So there's the pre-departure PCR, which the Singapore government request as well. There's the arrival PCR still done in Thailand.

And also in Japan. Some workplaces or schools have an organised structure for antigen self tests to be done onsite. So testing has become the norm for us and it will remain that way for a while, are for resilience. So resilience was always necessary for taking trips, but with COVID, we need to be resilient against quarantine We were never quarantined pre-COVID.

But this quarantine thing is still happening in some countries like China or Vietnam, Myanmar So it is important to remain resilient during your quarantine. And also if your arrival PCR at the airport turns positive, you may get quarantined. So there you need some resilience as well.

There's also the usual travel stress or maybe the psychological issues that arise during normal travel, and that is still there. And we need to be prepared for that. So I is for insurance. So we want to make sure that we have coverage for COVID 19 infection or unforeseen quarantine. But of course, it's important also to be fully covered for non-COVID medical issues and perhaps mental issues if your insurance covers for that So P is for preventive measures.

So I don't think pre-COVID we had any of this. But now days still face masks this remains a norm in Singapore. They just lifted the restriction to have face masks, face masks outside but still inside or on an aircraft or the train. We still need face masks. Personal hygiene is quite important. I just read a study that stated that face masks personal hygiene, like hand-washing and social distancing is almost equally vital.

For the prevention of COVID 19 social distancing or safe distancing or physical distancing, whatever you call it. We try to maintain a certain distance, especially from people we don't know, and also to avoid crowds. So this is all important for a safe trip for your students.

So how will trip leaders, school nurses and Grade 11 project week students prepare from now on for their trips? First of all, it's important to understand your destination and its COVID 19 risks. COVID 19 will stay around for a while and we will need to understand that this is an important aspect of preparation these days. Then, equally important is the non-COVID risks.

We've forgotten that other countries may have risks like tuberculosis. Or malaria, or Zika or dengue, and these are equally important as the COVID 19 risks. And we'll have to inform ourselves about these. Moving on to safe travel and preventive measures in flight during travel, and also in your country of destination Again, it's a repeat, but it's the mask wearing, hand-washing, social distancing, ventilation, avoiding crowds.

These are important. Still and will remain important for a while. Mental resilience is something that we need to ensure there is the quarantine that may be scheduled and necessary. And there may be some unforeseen positive PCR results that require unforeseen quarantine. And there may be some changes in border policy that may delay your trip home or change your itinerary in some way.

And lastly, the medical kit that we take. So we've always had to take the over-the-counter medication or the first aid items in your suitcase. But these days, it might be good to take a rapid test kit and HRT so that you can do a self-test during your travel, especially if you're not feeling well. So these are some changes.

And I've again highlighted the parts in red as the post-pandemic changes to the preparation So finally, a bit about the digital tools available to the trip leaders and the school teachers to help in their research about a destination before the trip. So here you see the Internet portal the teachers can log in with their membership number to access the member portal and you see the page for South Africa.

Here we have a page for every country under the country page, you have information about what vaccinations are recommended or what kind of medical facilities can be found. The names of some of our preferred network providers. Also, whether the tap water is safe to drink. What kind of diseases are common in that country? There's also information about the security situation and for some of the bigger cities, we have city level information as well.

The same types of information can be found on the app. If you download it onto your phone. You can also research specific diseases like if you would like to know more about dengue fever or malaria, you can look it up and you will find information about common symptoms, how to diagnose, what's the treatment, prognosis, that kind of information you can find on this site.

So if the teachers are unable to fulfil their research through this app or the portal, they always have the option to call in to International S.O.S. Pre-Trip for some advice. So some teachers call in about specific questions about their destination that wasn't found on the portal, or some of them call in about specific students cases. So if you have, for example, a patient with Type one diabetes and you are concerned about how to control their blood pressure, we can provide that type of medical advice over the phone or over email.

So not only diabetes, they can call in for any type of condition that they have concerns about So another tool that the teachers have access to is a very recent addition to our assistance portal or assistance app, and it's called the COVID Trip Planner. So the quick trip planner will enable the trip leaders or the teachers to better understand travel restrictions and requirements for specific trips and hopefully this will avoid any unnecessary quarantine time or trip delays.

So what you do is you key in the nationality and also the vaccination status of a certain group. And depending on the country of departure and the country of arrival and their restrictions, the teachers will be able to understand what kind of requirements will be necessary to enable this trip. And as everyone knows, UW teachers are juggling nationalities, student nationalities from various countries.

So hopefully this tool will be able to facilitate their understanding in how they need to proceed in order to make the trip happen.

Thank you very much for joining me today. I am a parent who absolutely adores the outdoor education program at UW SAE. And it is one of the top reasons why we wanted to go to this school. Every time my boys come back from a school trip, they show many, many positive changes, such as a renewed appreciation for flushing toilets, running water and hot showers.

I feel very honoured to be part of an organisation that provides strong support for this initiative and earnestly hope that school trips can resume soon in a safe way.

I've pasted in and provided a number of additional resources and the links below this video. Should you wish to explore this topic in more detail. My colleagues Shalini and Krystal will be joining the networking room to continue our discussion and we would love to see some of you join as well. Thank you again for your time and for taking an interest in managing the health and safety of our students and our teachers as we return to travel Thank you again and I hope you enjoy the rest of your sessions.