Microsoft word - orientation health matters 2013_07_30
(and some other matters)
Basic Immunizations & Malaria Prophylaxis
You basically need to be up-to-date on your 'shots'. This would mean all the usual childhood vaccinations. In particular:
Tetanus: Have you had a tetanus booster shot within the past 10 years?
Beyond that, there are others to consider, but probably not mandatory for a short-term mission ~
Hepatitis A: The important hepatitis is probably Hepatitis A that is food borne. Hep A is
everywhere so it is probably good to get the vaccine if you have not had it yet.
Hepatitis B is blood borne and it is unlikely that you would have a Hep B exposure while
you are here. However, it is now one of the standard US childhood immunizations and you may want to consider getting vaccinated if you have not had been previously.
Typhoid: You might also consider typhoid immunization. The oral vaccine is probably
better. Primary vaccination with oral Ty21a vaccine consists of a total of four capsules, one taken every other day. The capsules should be kept refrigerated (not frozen), and all four doses must be taken to achieve maximum efficacy. Each capsule should be taken with cool liquid no warmer than 37°C (98.6°F), approximately 1 hour before a meal. This regimen should be completed 1 week before potential exposure.
People are worried about malaria. The CDC recommends malaria prophylaxis for
some parts of the country
. Malaria is not common in along the southeastern coastal area
you are concerned and want to take something, the preferred prophylaxis against malaria would
Chloroquine (brand name Aralen™ and generics) must be started one week before arrival in the malaria-risk area, taken weekly while there, and continued weekly for four weeks after leaving the malaria-risk area.
Information on all the types of malaria prophylaxis is available for your physician at:
The CDC site recommends going to a travel physician or clinic, but that is generally very
expensive and any primary care physician can perform the same services from the CDC
information. Other health considerations ~
The major health threat
here is the sun.
Plan to use sunscreen or other
protection, a hat, etc.
You may want to consider bringing your favorite mosquito repellant. Long sleeves
and pants with long legs may also help. Light colored clothes may help (mosquitoes like dark
Dengue is present here, but there is nothing to do about it except avoid day
Health (and other) Matters Anita & Michael Dohn Updated: July 2013 Page 1 of 3
Cholera returned to the island after being imported by aid workers after the Haiti
earthquake. It appears sporadically, but as long as you use purified water and eat at known
locations, it should not be a problem.
Rabies is around. It is best to avoid street dogs and other animals. It is very unlikely that
you would run into rabies. If you are going to be working with animals (such as a veterinary
mission), then check on the rabies vaccine and other measures to avoid infection.
If you have any regular medications, you should plan to bring enough of them
along. “Enough” means some extra days, because sometimes flights get delayed or cancelled.
Some people are interested in evacuation insurance. It is usually really
cheap because it is so rare that anyone has to use it. It is sometimes part of a standard trip
insurance policy. WHAT TO WEAR
This is the tropics. It is hot and you want to dress accordingly. Cotton fabric “breathes” whereas
most synthetics will feel “sticky” during the heat of the day. Sandals are fine, but closed toes
shoes offer more toe-protection when walking on uneven surfaces or unpaved roads. For women,
modest styles (shorts but not short-shorts, and light weight blouses but not halter tops, for
example) are better for Christian mission trips. For those working in the Clinic, dress should be
appropriately professional (“business casual”). TRAVEL DOCUMENTS
US Citizens just need passports. US citizens can buy a tourist visa on arrival for US$ 10 cash (see below). The tourist visa is presently good for two months (though this may change periodically). After two months, visitors must pay additional fees either at the Migración office in Santo Domingo or as a cash payment when clearing immigration on leaving the country.
If young people under 18 years of age are not accompanied by both parents or guardians, additional documents are advisable. The Dominican government requires and the US Consulate strongly suggests having the notarized documents.
a) If a minor is traveling with one parent, the other parent should complete a notarized
statement granting permission for the minor to travel with the named accompanying parent.
b) If the minor is traveling without either parent (such as on a short-term mission trip), then
both parents should sign a notarized statement granting permission for the minor to travel with the group and specify the name of the adult with the group to whom they have given the responsibility for the minor.
It may be that no one ever asks to see the notarized travel permission for the young person. However, if Customs and Immigration does want to see it and it isn’t available, there can be travel delays and inconveniences.
There are several international airports in the Dominican Republic. The most convenient and easiest airport for coming to San Pedro de Macorís is Las Americas Airport in Santo Domingo
Health (and other) Matters Anita & Michael Dohn Updated: July 2013 Page 2 of 3
(airport code SDQ). It is about a 50 minute drive. The other airport in the area is in La Romana (LRM).
The airline usually gives you a customs form to complete before landing (airlines often pass them out as the first thing after getting airborne). If you do not get them from the airline, you can pick them up in the Immigration area (usually). When the form asks for your address in the Dominican Republic, you can use the Clinic address:
C/ Sánchez #9, Miramar, San Pedro de Macorís, Rep. Dom.
The arrival procedure here is simple. You have to buy a "tourist visa" after arrival. They are for sale for US$ 10 (usually best to pay cash) for each person along the right hand side of the immigration area (usually a line waiting to buy the tourist visas unless you are the first ones off the plane). Basically, the tourist visa is just a way to charge an entrance tax, and they will collect the visa as you get processed through immigration.
After immigration, you go to the baggage claim area. After getting your luggage, you have to
pass through Customs. As you enter the line for Customs, you will need your luggage claim
that you got from the airline when you checked your baggage. They will check the
stickers against the tags on your bags to confirm that you have your own luggage. Usually,
passing through the "Nothing to declare" lane is simply a matter of handing-in your customs
Then, follow the hallways to the exit and we will meet you there.
Useful Telephone Numbers:
Dohn home number: +1 809 246-1718 Michael’s cell: +1 809 357-5155 Clinic Community Health: +1 809 526-7731
Health (and other) Matters Anita & Michael Dohn Updated: July 2013 Page 3 of 3
Psychosomatik in der Medizin – im Spannungsfeld zwischen Patient und Doppelblindversuch - einige Gedanken dazu Von Dr. med. Ulrike Banis In der ärztlichen Ausbildung gab es während meines Studiums ein einziges Seminar zur „Psychosomatik“, in dem die Biographie des Patienten und seine seelischen Verletzungen und Traumen zur Erklärung seiner Symptome herangezogen wurden. Dieses Semi
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