More and more people are going abroad for medical care.

Before you or a loved one, make this choice, please read what the Centers for Disease Control (CDC) has to say on the subject.

“Medical tourism” refers to traveling to another country for medical care. It’s estimated that up to 750,000 US residents travel abroad for care each year. Many people who travel for care do so because treatment is much cheaper in another country. In addition, a large number of medical tourists are immigrants to the United States returning to their home country for care. The most common procedures that people undergo on medical tourism trips include cosmetic surgery, dentistry, and heart surgery.

Risks of Medical Tourism

The specific risks of medical tourism depend on the area being visited and the procedures performed, but some general issues have been identified:

• Communication may be a problem. Receiving care at a facility where you do not speak the language fluently increases the chance that misunderstandings will arise about the care.
• Doctors may reuse needles between patients or have other unsafe injection practices, which can transmit diseases such as hepatitis and HIV.
• Medication may be counterfeit or of poor quality in some countries.
• Antibiotic resistance is a global problem, and resistant bacteria may be more common in other countries than in the United States.
• The blood supply in some countries comes primarily from paid donors and may not be screened, which puts patients at risk of HIV and other infections spread through blood.
• Flying after surgery increases the risk for blood clots.

What You Can Do

• If you are planning to travel to another country for medical care, see a travel medicine practitioner at least 4–6 weeks before the trip to discuss general information for healthy travel and specific risks related to the procedure and travel before and after the procedure.

• Check for the qualifications of the health care providers who will be doing the procedure and the credentials of the facility where the procedure will be done.
• Make sure that you have a written agreement with the health care facility or the group arranging the trip, defining what treatments, supplies, and care are covered by the costs of the trip.
• Determine what legal actions you can take if anything goes wrong with the procedure.
• If you go to a country where you do not speak the language, determine ahead of time how you will communicate with your doctor and other people who are caring for you.
• Obtain copies of your medical records, which should describe any allergies you may have.
• Prepare copies of all your prescriptions and a list of all the medicines you take, including their brand names, their generic names, manufacturers, and dosages.
• Arrange for follow-up care with your local health care provider before you leave.
• Before planning “vacation” activities, such as sunbathing, drinking alcohol, swimming, or taking long tours, find out if those activities are permitted after surgery.
• Get copies of all your medical records before you return home.

Guidance from Professional Organizations

• Organization for Safety, Asepsis, & Prevention’s Travelers Guide to Safe Dental Care
• The International Society of Aesthetic Plastic Surgery Guidelines for Travelers
• CDC Yellow Book 2014 information on Medical Tourism

In this  post, Denise A. Somsak, MD details the kindergartner’s well visit. Dr. Somsak is a pediatrician and mother with young children. She blogs at www.pensivepediatrician.com where she posts about areas of interest and concern for parents.

My fifteen minute office visit is only 0.003% of the kindergartner’s total year, but it’s the culmination of our priorities as a society.  How communities, parents, educators and doctors work together to invest in our children is reflected in the kindergarten check up.  When a child is healthy physically, socially, emotionally and intellectually that means the parents have succeeded on many levels and sometimes in spite of challenges like poverty, prematurity, speech delay, or maternal depression.  When all children even those with disabilities can access quality education and be prepared to learn, our future is more secure.

Kindergarten readiness starts at birth with a safe and nurturing home environment filled with books and time for play, regular check ups, good nutrition, a quality pre-school experience with a chance to practice sharing and empathy with peers, and exposure to simple outings like the library or museum.

The five year well visit is a time to celebrate the child’s accomplishments, unique skills, and review health behaviors.  The child can tell me how often he brushes teeth, his favorite food, and what he watches on TV.  She can tell me if she rides in a booster seat or wears a bicycle helmet.  I ask who lives in the home and who the child’s best friends are.  She answers with confidence or looks to her parent for help.  At this age, most children know their full name and sometimes part of an address or phone number.  They cooperate with the exam easily and are curious about my stethoscope and lights.  Children enthusiastically draw me a self portrait.  They excitedly handle the book that I provide while I ask parents about reading in the home.  They wait quietly and even though they inevitably interrupt, they are easily redirected.

This interaction with the child demonstrates what I think are the three most important aspects of kindergarten readiness:

1. Communication and social-emotional skills
2. Inquisitive nature
3. Self control

What I measure and review:

• Height, Weight and BMI (Body Mass Index).  All families, fat or thin, need more information on nutrition, the importance of physical activity and how it relates to school success.
• Vision and Hearing.  All children especially those at risk of learning disabilities, need their senses working properly to learn and should be referred if they cannot complete the screen.
• Motor skills. Children demonstrate skipping or hopping.  A crude test of cognitive and fine motor function is counting the number of body parts on a child’s drawing of a person.  As a child ages, she adds more parts with more accurate proportions.
• Developmental Screening. The AAP recommends developmental screening with a structured questionnaire at 9, 18 and 24 or 30 months of age.  Hopefully, if a problem was identified, it has already been addressed.  The AAP does not recommend screening for social emotional disorders with a validated tool nor do they recommend a general developmental screen at the five year check up.  I screen at this age only if their is a concern, but some pediatricians formally screen all children this age.
• Dental home.  I encourage my patients to see a dentist as soon as they have teeth.  By five, they best be getting regular dental cleanings.
• Literacy and screen time. Books are good.  Computers can be educational in moderation.  Although an effective babysitter, the television should be turned off most of the time.  It disturbs sleep, encourages sedentary behavior, and even educational programming has advertisements that can send children unhealthy messages.  Video games, at five?  Are you kidding?
• Routines and sleep. Children need to be well rested for school especially if attending a full day program which unlike preschool will no longer accommodate a nap.   A half day or whole day of kindergarten can both adequately prepare children for first grade.  The choice should be made based on the needs of the child and the educational environment of the home and school.
• Update vaccinations.  Because of the success of vaccinations, pediatricians are less worried about severe acute illnesses. They can focus on prevention of disease and injury and help parents understand the behavior and development of their children.

The kindergarten visit is a snap shot of the child’s health and potential.  My signature on the physical form indicates that I am one leaf on a huge tree in the forest of the child’s life.  Parents have the hard work.  Check out these resources on kindergarten readiness and literacy for more details on how to prepare your child, your patients, our future:

A checklist of kindergarten readiness from the Ohio Department of Education.

A quiz to see how effectively your home promotes literacy.

A guide to reading with your child from toddler years to third grade.

Ideas to promote kindergarten readiness from the National Association for the Education of Young Children