Treating Diseases From Abroad Right Here at Home: A Medical Challenge for a Globalised Reality

Imagine that you are a family doctor on duty in the emergency department at your hospital. At 9:00 pm, in walks 24-year-old Daniel, who has started today with a fever and a cough. Maybe it’s COVID-19, you think to yourself. But the antigen test comes back negative. The X-ray appears to show an interstitial pattern.

Every doctor who has worked in an emergency department has encountered this sort of situation. In fact, it is likely that Daniel has a viral infection, such as influenza, or perhaps an incipient community-acquired bacterial pneumonia. But if you dig a little deeper into his history, you find that he returned from a 30-day trip to Southeast Asia just one week ago. What possibilities does this open up? Should you suspect histoplasmosis? What about acute schistosomiasis? Or Q fever? Or perhaps leptospirosis? How do these unsuspected diagnoses fit into your usual repertoire of options?

Globalisation permeates the whole of society, including medicine. We need only recall the COVID-19 pandemic to understand how international mobility affects health

There are answers to all of these questions, but to discover them you have to put yourself in Daniel’s shoes, delve into his travel itinerary, eat with him at street food stalls, explore the caves of Phong Nha, kayak along the Mekong River and tour the rainforests of Chiang Mai. And I’m afraid you also have to go back to a few days before the trip and join Daniel at his pre-departure medical visit: What vaccinations did he receive? What other preventive measures did he take?

But your reflection exercise with Daniel doesn’t end there. At some point, you have to shift your focus away from his history and look at his case through the lens of medical geography: What outbreaks are occurring in Southeast Asia? Is malaria still present in Vietnam? Are Schistosoma cercariae still swimming in the Mekong River with impunity?

We doctors need tools and knowledge to diagnose and treat diseases that we are not accustomed to seeing, but which—now much more than ever—are an undeniable part of our reality

Contrary to what you might think, we are not talking about anecdotal cases or bizarre diseases that attract the attention of just a handful of specialists. Globalisation permeates the whole of society, including medicine. We need only recall the COVID-19 pandemic to understand how international mobility affects health. Every day, we doctors encounter patients like Daniel, who was in Hanoi last week and is in Barcelona today. But we also see migrants who have arrived in Europe after a dangerous journey, as well as aid workers returning to their country of origin after spending several years in tropical regions. Against this backdrop, we doctors need tools and knowledge to diagnose and treat diseases that we are not accustomed to seeing, but which—now much more than ever—are an undeniable part of our reality.

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