1. CIWEC – Travel Medicine Center of International Repute
Prativa Pandey, M.D
Medical Director
CIWEC Hospital
CIWEC Clinic Travel Medicine Center

2. Case 1
37 yr old American male arrived in Nepal in May after extensive travel Feb-May
Climbed Mt. Kilimanjaro and visited serengeti national park in Tanzania

3. 37 yr old American male traveled to:
Travel to Brazil, Argentina, South Africa, Zimbabwe, Zambia, Tanzania, Kenya, Bahrain and then Nepal, climbed Mt. Kilimanjaro and visited Serengeti national park. From Tanzania, he went to Kenya to fly into Nepal via Bahrain. He was seen at the CIWEC Clinic 2 days after arrival in Kathmandu.

4. Seen 2 days after arrival in Nepal
Fever and chills x 8 hrs
insect bite to left foot with pain and swelling

5. Case presentation Started on antibiotic for probable skin infection
Did not improve
Ongoing fever, chills x 3 days, slightly short of breath
All tests normal
Special test done

7. Diagnosis: East African Trypanosomiasis or Sleeping Sickness

8. Trypanosomiasis - East African Sleeping Sickness
Tsetse flies only found in Africa
Medicine to treat this disease, Suramin not available in all of Asia
Patient flown back to Boston after phoning doctors in Boston about his diagnosis
Suramin brought urgently from CDC and was ready when patient reached the ER in Boston

9. Highlights of the case
High index of suspicion on account of travel history helped confirm diagnosis
Early notification of treating doctors in U.S. helped obtain quick treatment.
Following this case several cases were discovered in East Africa
This is the value of Travel Medicine

10. The Practice of Travel Medicine

11. History of the CIWEC Clinic
Established in 1982 to take care of expatriates working for a Canadian water project: Canadian International Water and Energy Consultants (CIWEC)
Gradually other expatriates and foreign tourists began to use the clinic
Clinic made it into the guide books

12. David Shlim joined the clinic in 1983 and worked for 15 years
Kitchen of rented house was the laboratory
Medical research conducted on traveler/expat issues
Prativa Pandey joined in 1993

13. Select Publications
Etiology of diarrhea among travelers and foreign residents in Nepal. Taylor DN, Houston R, Shlim DR, Bhaibulaya M, Ungar BLP, Echeverria P. Journal of the American Medical Association 1988;260:
Helicopter rescues and deaths among trekkers in Nepal. Shlim DR, Houston R. Journal of the American Medical Association 1989;261
Rabies immunoprophylaxis strategy in travelers. Shlim DR, Schwartz E. Houston R. Journal of Wilderness Medicine 1991;2:15-21.
Viral hepatitis in foreign residents and travelers in Nepal. Schwartz E, Innis BL, Shlim DR, Snitbhan R. Journal of Wilderness Medicine 1991;2
An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Shlim DR, Cohen MT, Eaton M, Rajah R, Long EG, Ungar BLP. American Journal of Tropical Medicine and Hygiene 1991;45:

15. CIWEC Clinic Travel Medicine Center- 2005

17. What has helped us grow?
Name recognition – have been around for 32 years
We provide what the travelers need
Have consistently provided good quality work
Stay connected with the global Travel Medicine community
High profile presence in the International Society of Travel Medicine (ISTM) – 2 of our Medical Directors have been the ISTM Presidents
Be an expert in your area of work
Participate in Scientific research work and publish papers

18. Challenges of growth – from a clinic to a hospital
From 20 staff to 100 staff
Had to hire managerial staff at multiple levels
Multiple power back up systems
Biomedical engineering staff on standby
Fiscal discipline
Although bigger, try to preserve a small clinic environment

19. Global Surveillance Network of the ISTM and CDC - GeoSentinel
First developing country clinic to join GeoSentinel
Monitor emerging and re-emerging diseases in travelers
Many research papers that have identified:
disease trends in travelers
high risk travelers
country or region specific risk

21. What is it that we do, we do well
Cleanliness/hygiene
Motivated staff
Confidentiality issues
Compassionate care

22. What is it that we do, we do well
Diagnose before treating
Communicate – patients, third party payers
Explanation of treatment and explain what may not be known
Explain what is the best treatment for this condition even if that is not available in Nepal
Patient centric approach

23. Good management starts with good communication!