Can I put in a plug for Barefoot Winery (www.barefootwine.com). In the past few months I have been at a few charitable fundraisers, and they were present at each one. This is their way of marketing themselves – by donating their wines for auctions or serving to benefit various charities and causes. The wines are great. Give them a try.

Summer in The Travel Clinic has finally slowed down. Slews of young people have left for faraway places to get a taste of new sights, sounds, smells and experience. Their most important experience will be that of poverty. While it may be questionable as to whether these brief voluntourism trips make a difference to those at the receiving end, I am convinced that they at least change those making the trip. One prominent Nigerian author speaking in Toronto suggested that instead of sending your kids on these trips, send the money. Both are needed.

Not everything, or every illness upon returning from the tropics is necessarily tropical. This was recently brought home to me by a patient who was diagnosed with traveller’s diarrhea on her return from an exotic locale. In fact, she had cancer of the ovary which was responsible for her gastrointestinal symptoms. So while it is important to tell your doctor that you may have returned from the tropics, remember, not everything is tropical. Ask the question, “Could it be something else?”

I’ve been involved in travel medicine for more than 25 years now. During that time, I have seen many changes. Changes in where people go …and where they don’t go, and more importantly why they go.

As a kid, my parents took me exclusively to destinations within driving distance – Ottawa, Cleveland, New York, Detroit. We saw the Parliament buildings, the Yankees, Jimmy Brown and the Cleveland Browns, and the Ford auto plant.They were great trips. Many of my friends also got to visit Florida. In high school, Stratford was the only exotic location offered by the schools, and I chose not to go.

In 1972, at the age of 22 and in the middle of my medical education, I embarked with my friend Howie on a backpacking trip through most of South America. This was not a popular destination at the time, but my passion for Butch Cassidy and The Sundance Kid led me there. Europe was where most people were headed. Machu Picchu was so uncrowded in those days that you could unroll your sleeping bag on the terraces and have a front row seat for the sunrise the next morning.

Since that time, I have been to every part of the world with the exception of China and Southeast Asia. Still, people come to my office, see my old photos and memorabilia, and think that I am well travelled. Well kids these days get much more travel and experience under their belts than I ever did.

All of my three children, Benjamin, Michael and Carrie, got to travel with me to so-called exotic destinations such as Ghana, Nepal, Guatemala, Uganda and Rwanda. Benjmain subsequently spent a year volunteering in Northern Ghana at Horizon’s Childrens’ Centre after his graduation. Many high schools routinely take student trips to just about every far-off locale. Service work, or humanitarianism, is a key component of most of these experiences. Such trips kindle the students’ interest and desire to travel and work abroad.

Studying international development was not a common option when I was in university.

Now, almost every school, certainly in Ontario, provides opportunities to study about the subject, and to travel and work abroad. CUSO (Canadian University Students Overseas) was the main volunteer sending NGO when I was in school. Today there are countless excellent organizations providing the opportunity for international travel, education and work experiences. VSO, Canadian Crossroads International, Right To Play, Engineers Without Borders, Journalsts for Human Rights, Scarborough College International Development Studies and Humber College International Project Management are a few that I have the pleasure of working with. In addition to these “not for profit” organizations, there are countless other organizations who will be only to happy to help you arrange an unforgettable experience almost anywhere you can imagine.

Some may question whether going abroad as a volunteer makes “ a difference”. I think it does, but I will expand on this in a future posting. My website lists many of the organizations which will help you find volunteer, and not so volunteer experiences abroad. I wish they had all been available thirty years ago.

In my early days as medical advisor to VSO Canada (www.vsocanada.org) , I would frequently get woken up in the middle of the night by a worried volunteer on the other side of the world. The sound quality was usually poor, and it generally took a few calls to get the whole story. Well how things have changed.

Last night’s Passover ensured that our family was at the forefront of cyber simchas. My brother Joel, who has been teaching this year in Cochabamba, Bolivia, was conveniently plugged into our family celebration via the internet and Skype. He “sat” at the end of the table where he had a good view of my Dad who was leading the seder, and he could salivate over the delicious food … the gefilte fish, the meatballs, the veal, the turkey, the stuffing and the kosher wine (which he could have found in nearby Chile). Still no way to download food over the internet, though perhaps smells are not that far off.

And with volunteers in Ghana or Vanuatu who need my help abroad, they can now e-mail me pictures of their rashes, their Bell’s Palsy or all of their lab tests from their doctor’s visit. Phone calls are crystal clear, though there is not yet software to eliminate the 12 hour time difference often encountered.

Part of the challenge of travelling used to be that you were away from your friends and family. While this is still true, cases of severe homesickness requiring repatriation have dropped drastically over my career. And keeping families connected at important times is indeed a great benefit.

Check out www.blurb.com . On this site, you can publish your own coffee table book of photos. Choose the size of the book, the layout, make a lovely cover, chose whether to add text or not. Do it all on the web, and they will promptly send you the finished version in a week or so. Even consider putting your finished product up for sale, though more likley you are keeping it for personal use.

If I had had this thirty-five years ago when I started wandering, well, I would have needed a pretty big bookshelf! Having a grandchild, like me? What a great way to preserve those priceless looks.

OK. This is not really about travel medicine, but one of my greatest joys of travel is the pictures, and the memories of taking those pictures. So, take a look, and let me know what you think.

England was a breeze - a cold breeze, and hypothermia, along with overeating were probably the greatest health risks. I tried taking some melatonin before my departure to ward off jet lag, but forgot to take it at my destination. I managed with a hot shower, a cappuccino and a good night’s sleep. We saw a fair bit, including Birmingham, Stratford, York, Windsor and over to Whitby on the coast, the home of the world’s best fish and chips. Having built in guides and chauffeurs like Ben and Ros was a great bonus. There is no better way to see  country than with people who live there. We managed to bypass London, and thankfully British Airways’ terminal 5 as well.

England is certainly not the cheapest country to visit, and perhaps that is one of the attractions of the tropical countries I am usually drawn to. But there’s nothing like god bacon and eggs and sausage and tomato and beans in the morning, followed by scones and clotted cream a few hours later!

If the band does as well as the infection, they are in for a wild ride. Recent reports suggest that dengue is on the increase - in Brasil, the Philippines, Vietnam, French Polynesia, New Caledonia, and likely in other countries (source - ProMED). India had a smashing season last year, along with another tonguetwister, Chikungunya virus!

Dengue is another disease of poverty. Yes, it takes a warm climate for the Aedes mosquitoes to thrive. But other factors, like poor sanitation, lack of public health and urban migration all play a role. While sitting here in the Toronto winter doesn’t really give a hint of global warming, there is the perceived threat that under such a scenario, the dengue mosquitoes will thrive further north, and develop faster.

Cruisers are usually not at risk for malaria as they are usually back on board sipping their gin and tonics by sundown. But the dengue vector is a daytime feeder, just waiting for the throngs with their wallets and digital cameras.

So if you are headed south, type dengue and your destination into Google, just to see what is going on. Put on your insect repellent, and get ready to bargain.

On the yellow fever front, Brasil, and now neighbouring Paraguay and Argentina, have experienced a resurgence of yellow fever, a deadly mosquito-borne virus. This includes the region where Iguassu Falls is located. Again, while the risk may be low, a yellow fever shot is highly recommended as the illness has up to a 50% mortality rate. While it is probably not necessary for those just visiting Sao Paolo and Rio de Janeiro, Brasilian authorities and cruise ship operators are getting pretty picky!

This link will show you the yellow fever risk areas in Brasil …  http://wwwn.cdc.gov/travel/contentUpdatedYFMapBrazil.aspx