Subject: FW: Trip info
From: "O'Connor, Kevin C. COL USA WHMO/WHMU" <[email-masked]>
To: "Hunter Biden" <[email-masked]>
Date: Fri, 8 Apr 2011 16:26:06 -0400

FYI
Safe Travels....
V/R  KO

-----Original Message-----
From: O'Connor, Kevin C. COL USA WHMO/WHMU 
Sent: Friday, April 08, 2011 2:11 PM
To: [email-masked]'
Cc: Hartung, Charles S. LCDR USN WHMO/WHMU
Subject: Trip info

Cheryl,  

Should be okay with standard travel vaccines for short-term travel to Taipei and Beijing.  Both are decent risk for traveler's diarrhea, and both have a couple exotic diseases that we can play with when you get back...  I'll copy some info below.  "Go ugly early" with respect to treating the GI stuff.  Here are the hospitals that we'd recommend, as well as some good contact numbers and some medical trivia:

Hospital that would be a good first choice in Taipei is:

National Taiwan University Hospital 

7 Zhong Shan South Road 
Taipei, Taipei
Taiwan

GPS Coordinates:  
Latitude 25.04060 Longitude 121.51870 

Main Phone: [+886] (02) 2312-3456 
24 Hr. ER Phone: [+886] (02) 2356-2264 
Web Address: http://ntuh.mc.ntu.edu.tw/english 

We haven't been there, but our sources recommend NTUH.

Hospital that would be a good first choice in Beijing is:

Peking Union Medical College Hospital 

1# Shuaifuyuan, Dongcheng District 
Beijing, China 100730
China
		
GPS Coordinates:  
Latitude 39.91291 Longitude 116.40266 
		
Main Phone: [+86] (8610) 6529-5269 
24 Hr. ER Phone: [+86] (8610) 6529-5284 

We recently surveyed PUMCH, and our "go-to" POCs are:

Melissa Cox, NP, MPH 
Phone: 8610-8531-4777 
Home: [email-masked] 
Fax: 8610-8531-3888 

Dr. Wayne Quillin 
Regional Medical Officer (State Department)
cell: 139-1127-0474
[email-masked]. 
Regional Medical Officer Duty Phone: 135-0109-9206 

Li Wenyuan (Susan)
Chinese RN
135-0109-9258 
The telephone number for the international ED nurses' station is 8610-6529-5284. All of the nurses at this station will speak English.

TAIWAN:
*	Tuberculosis is common in all developing countries and also presents risk in certain developed countries. This country, while not in the highest risk category, has an incidence of over 25 cases per 100,000 population. Travelers planning to stay more than 3 months should have pre-departure PPD skin test status documented. Those who expect to have close contact with the local populace should be tested if staying more than 1 month. Travelers should avoid persons who are coughing in crowded public places whenever possible. Domestic help should be screened for TB. 
*	Hand-foot-mouth disease (HFMD) occurs throughout the year, but peaks between May and July. Frequent hand washing, especially in children, is recommended. 
*	Dengue fever presents significant risk in urban and rural areas. Risk is greatest in Taipei Municipality, Kaohsiung Municipality and County, and Tainan City and County. The highest number of cases is reported from July to November. Daytime insect precautions are recommended. 
*	Lyme disease occurs only rarely. Risk to travelers is presumed to be very low. Seasonality and infected regions are unclear. Tick precautions are recommended. 
*	Trematode infection (liver, lung, and intestinal flukes): risk is present. Travelers should avoid undercooked fish and shellfish, and raw vegetables and salads outside of deluxe establishments. 
*	Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive. 
*	Marine hazards may include jellyfish, coral, and sea urchins. 
*	Security-The FAA (U.S.) has determined that the civil aviation authority of this country oversees its air carriers in accordance with minimum international safety standards. 
MEDICAL CARE 
*	A high level of medical care comparable to that in other industrialized countries is available in Taipei. Adequate medical care is available in the rest of the country but is not up to the standards of industrialized countries. 
*	For emergency services, dial 110 for police and 119 for ambulance or fire. 
*	The Taiwanese police department also offers a 24-hour telephone line for foreigners in English (tel. 0800-024-111). 
*	Taiwanese regulations require ambulances to have emergency equipment and supplies and to be staffed by trained medical personnel. 
*	A recompression chamber is located in Keelung. Before diving, check that facilities are operational. 
*	Cash payment may be required prior to treatment, including emergencies; some private clinics may accept credit cards. 
*	Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive. 

CHINA:
*	Hand, foot, and mouth disease (HFMD) occurs throughout the year, but peaks between May and July. In 2008 and 2009, rural areas in the eastern and south-central regions were most affected. Frequent handwashing, especially in children, is recommended. 
*	Tuberculosis is common in all developing countries. However, this country has an incidence of over 100 cases per 100,000 population, the highest risk category. Travelers planning to stay more than 1 month should have pre-departure PPD skin test status documented. Travelers should avoid crowded public places and public transportation whenever possible. Domestic help should be screened for TB. 
*	Crimean-Congo hemorrhagic fever: Sporadic activity occurs in Xinjiang Region (northwest China). Transmission is via infected ticks or contact with blood or infected tissue of livestock. Infection in travelers is rare. Tick precautions are recommended. 
*	Dengue fever presents low risk in urban and rural areas of the southern provinces of Guangdong, Guangxi, and Hainan. Risk in other regions of the country appears to be low or non-existent. No risk exists in Shanghai or Beijing. Daytime insect precautions are recommended. 
*	Lyme disease occurs mostly in northern and northeastern provinces through the warmer months. Sporadic cases are reported from other forested regions. Tick precautions are recommended. 
*	Schistosomiasis, transmitted by waterborne larvae that penetrate intact skin, presents significant risk in Lake Dongting, Lake Poyang, the Yangtze River and surrounding marshlands (in Hunan, Jiangxi, Anhui, Hubei, and Jiangsu provinces), and mountainous regions of Sichuan and Yunnan provinces. Travelers should avoid freshwater exposure in these areas. 
*	Hantavirus: Hantaan virus, a hantavirus causing severe hemorrhagic fever with renal syndrome, is transmitted by rodents and occurs in eastern provinces including Heilongjiang, Jilian, Liaoning, Shaanxi, Shandong, Zhejiang, and Hebei, and also Inner Mongolia Autonomous Region. Cases of Seoul virus, a related virus, have also been reported in Beijing and Shenyang. Risk is minimal for most travelers. Avoid contact with mice and voles (including their excreta) in rural areas and rats in urban areas. 
*	Avian influenza H5N1, excreted in large amounts in the droppings of infected birds, is endemic. Sporadic human cases acquired by direct contact with poultry are reported in this country. The last human case was reported in May 2010. The last case in birds was reported in July 2010. China has reported bird and/or human cases of H5N1 throughout most of the country. Although risk to travelers is minimal, avoid places where direct contact with birds and/or their secretions may occur, such as live animal markets and poultry farms. Well cooked chicken is safe to eat. Current influenza vaccines are not protective. Oseltamivir is effective. 
*	Trematode infection (liver, lung, and intestinal flukes): risk is present. Travelers should avoid undercooked fish and shellfish, and raw vegetables and salads outside of deluxe establishments. 
*	Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive. 
*	Monkey bites occur among tourists. Monkeys may transmit a number of diseases, including rabies and herpes B. Avoid feeding monkeys; if bitten, immediately soak and scrub the bite for at least 15 minutes, and seek urgent medical consultation. 
*	Altitude sickness: Chemoprophylaxis with acetazolamide should be considered for travelers to altitudes above 2,400 meters (8,000 feet). The elevation of Lhasa (Tibet) is 3,700 meters. Much of Qinghai and Xinjiang and parts of Sichuan, Yannan, and Gansu have elevations above 4,000 meters. 
*	Pollution: due to the burning of soft coal during the winter, all major cities and especially those with heavy industry are heavily polluted with potential for significant exacerbation of respiratory conditions including asthma. 
*	Marine hazards may include jellyfish, coral, and sea urchins. 
*	Security-Warning against Travel: Due to military conflict in Burma's Shan State, a Canadian consular warning currently advises against non-essential travel to border areas near Burma, in the province of Yunnan. Other Information: Hotel rooms and communications may be monitored. The FAA (U.S.) has determined that the civil aviation authority of this country oversees its air carriers in accordance with minimum international safety standards. 
*	Safety Bulletin - Posted March 9, 2011
Demonstrations have been occurring in China since February 2011. There have been reports of foreign journalists being attacked and detained. Further demonstrations are scheduled. Travelers should avoid large crowds and demonstrations and monitor the situation through local media. 
MEDICAL CARE 
*	A high level of medical care is available at 1 or more internationally staffed hospitals in Beijing and Shanghai. Adequate medical care is available at 1 or more internationally staffed outpatient clinics in Beijing, Shanghai, Nanjing, Tianjin, Guangzhou, and Shekou, and may be available in other major cities. Adequate evacuation insurance coverage for all travelers is a high priority. In the event of a serious medical condition, medical evacuation to Hong Kong is likely to be necessary. Hospital accommodations, and medical care in general, are inadequate throughout the rest of the country, and advanced technology is lacking. Shortages of routine medications and supplies may be encountered. 
*	For emergency services, dial 110. Dial 120 for ambulance. Operators typically speak Chinese only. 
*	Ambulances do not carry sophisticated medical equipment. Injured or seriously ill travelers may prefer to take a taxi or other immediately available vehicle to the nearest major hospital rather than waiting for an ambulance. 
*	Hospitals in major Chinese cities often have VIP wards (gaogan bingfang), which are fairly modern and typically staffed with well-trained English speaking doctors and nurses. However, even in these VIP/foreigner wards, English-speaking patients frequently encounter difficulty due to cultural, language, and regulatory differences. 
*	Cash payment for services is often required prior to treatment, including emergency cases. Travelers will be asked to post a deposit prior to admission to cover the expected cost of treatment. Hospitals in major cities may accept credit cards. 
*	Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive. 
		
		Hope this is helpful!!
		
		V/R  Kevin

Kevin C. O'Connor, D.O., FAAFP
COL, MC, USA
Physician to the Vice President
Eisenhower Executive Office Building, Room 37
O: 202-757-2499
M: 202-757-7633
H: 410-721-8927
[email-masked]

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