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Iinternational Journal of Travel Medicine and Global Health Archive of SID Int J Travel Med Glob Health. 2018 Sep;6(3):88-91 doi 10.15171/ijtmgh.2018.18 J http://ijtmgh.com IInternationalTMGH Journal of Travel Medicine and Global Health Perspective Open Access Leaving Light Footprints – the Importance of Promoting Responsible International Travel Bryan Chang Wei Lim1,2, Gerard Thomas Flaherty1,2* 1School of Medicine, National University of Ireland Galway, Galway, Ireland 2School of Medicine, International Medical University, Kuala Lumpur, Malaysia Corresponding Author: Gerard Flaherty, MD, Professor, School of Medicine, National University of Ireland Galway, Galway, Ireland. Tel: +353-91495469, Email: [email protected] Received April 25, 2018; Accepted September 7, 2018; Online Published September 25, 2018 Abstract Irresponsible travel has the potential to harm both the traveler and the host destination. The subject of responsible travel is a major focus of the International Society of Travel Medicine, whose Responsible Travel special interest group has been very active in providing leadership for travel medicine practitioners in relation to the protection of local travel destination communities. Healthcare professionals have a responsibility to safeguard the dual interests of travelers and their hosts. This can be achieved by drawing the traveler’s attention to examples of irresponsible tourism during the pre-travel consultation. This perspective article aims to explore various aspects of irresponsible travel, including environmental damage travelers may cause; medical tourism and its impact on both the home and destination health service; voluntourism involving poorly prepared volunteers interacting with vulnerable communities in the host country; and sex tourism, including prostitution and child trafficking. Further research is needed to better understand the attitudes of travelers, travel health professionals, and the travel industry towards responsible tourism and to overcome barriers to its implementation. Keywords: Responsible Travel, Ethical, Medical Tourism, Sex Tourism, Volunteering Citation: Lim BCW, Flaherty GT. Leaving light footprints – the importance of promoting responsible international travel. Int J Travel Med Glob Health. 2018;6(3):88-91. doi:10.15171/ijtmgh.2018.18. Introduction in relation to the protection of local travel destination International travel is a privilege, not a basic human right. All communities from the undesirable impacts of tourism.3 of life’s privileges come with certain inherent responsibilities. Areas of particular expertise within the ISTM group include Global travel has expanded exponentially, such that annual ethical tourism, voluntourism, and sex tourism. Healthcare tourist arrivals have been predicted by the World Tourism professionals have an onus of responsibility to safeguard the Organization to reach 1.8 billion by 2030.1 The ease of dual interests of travelers and their hosts. This can be achieved modern air and cruise ship transportation has combined by drawing the traveler’s attention to examples of irresponsible with the increased prosperity of developing countries to tourism during the pre-travel consultation. It behooves greatly facilitate international travel. Current international the travel medicine professional community to maintain a travel trends have highlighted the sharp increase in outward heightened awareness of the importance of responsible travel travel from emerging economies in regions such as Asia and through education of travelers and the travel industry. The Africa.2 Travel overseas should be symbiotic; the traveler issue of responsible tourism has been somewhat neglected should benefit from exposure to other cultures and natural to date in the travel medicine literature.4 This perspective environments, while the destination community may also article will explore various aspects of responsible travel with a benefit socially and economically. However, irresponsible particular focus on voluntourism, sex and romance tourism, travel has the potential to harm both the traveler and the host and medical tourism. destination and lead to unforeseen consequences. The subject of responsible travel is a major focus of the Environmental Effects of Travel International Society of Travel Medicine (ISTM), whose Modern international travel is, by its very nature, damaging to Responsible Travel special interest group has been very active the natural environment. Jet fuel carbon emissions contribute in providing leadership for travel medicine practitioners to anthropogenic climate change and increase the carbon Copyright © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, providedwww.SID.ir the original work is properly cited. Responsible Travel footprintArchive of individualof SID travelers. While a mechanism exists should be made aware of infectious diseases which have to offset travel-related carbon emissions,5 it is unknown how been reported in travelers engaging in nature-based tourism. many travelers actually choose this responsible option owing These include rabies, histoplasmosis, brucellosis and Japanese to the individual cost involved. This environmental impact encephalitis. Nature-based tourists should also avoid activities is greater with more frequent travel such as business travel. that exploit wildlife for entertainment purposes, such as The development of non-fossil-based fuels by the aviation elephant riding or lion cub petting. They should also avoid industry (for example, hydrogen and solar powered air-craft) purchasing products derived from animals which have been will hopefully address this issue in the future. mistreated or unsustainably harvested. The responsible traveler should be aware of the effect of his/ her personal consumption behavior on the local environment Medical Tourism of the host country. One example is the overuse of disposable Medical tourism refers to travel across international plastic water bottles by trekkers along the Everest Base boundaries by individuals for the purpose of receiving medical Camp trail in Nepal. There should be cooperation between care which is unavailable or too expensive in their home destinations and the travel industry to enable travelers to country.12 While medical tourism which is properly regulated recycle materials when they travel as they would domestically. and held to a high standard may have beneficial outcomes Travelers should be conscious of the importance of conserving for individual patients,13 consideration should be afforded fragile natural habitats and scarce local resources such as clean to the unintended consequences of this multi-billion-dollar water. Recent examples of tourism-related environmental global industry. There is a risk of displacement of the local degradation include the destruction of delicate coral reefs medical workforce from the public healthcare system to the by recreational scuba divers,6 reports of the Croatian city private sector in popular medical tourism destinations such as of Dubrovnik being “overwhelmed by mass tourism,”7 and Thailand, India, and Malaysia. This imposes inevitable strains protests of Venetian residents against the tourist influx to the on the local delivery of public health services. Italian city.8 Traveling abroad for medical treatment also represents a An often-overlooked by-product of international travel challenge to the health service in the traveler’s home country. is the impact of tourist-led food consumption on local An example of this is the importation of multi-drug resistant agricultural food production. An example from Asia is the bacteria which have colonized medical tourists as a result detrimental effect of tourism on the livelihood of indigenous of inadequate antibiotic stewardship during their treatment farmers in Indonesia, who are being exploited by large scale abroad.14 This is compounded by difficulties in transmitting food producers that exert a disproportionate influence on operative reports and in communicating with the healthcare their agricultural practices.9 While the individual traveler may providers in the medical tourism destination. Organ feel understandably powerless when faced with this issue, the transplant tourism typically involves the travel of a wealthy lobbying potential of tourists with the travel industry is quite middle-aged patient from a developed country to a resource- significant. Tourism Concern is a not-for-profit organization poor country for the purpose of receiving a solid organ which seeks to protect the interests of local workers and the transplant, such as a kidney or liver, from an impoverished native environment.10 Responsible travelers should challenge donor.15 The medical follow-up of these unfortunate organ their tour operator or adventure travel company if they do not “vendors” is often woefully inadequate. A study by Naqvi et subscribe to the Tourism Concern Charter. al in Bangladesh highlighted the fact that organ donors often A descriptive study of 101 Inca Trail porters in Peru suffered prolonged post-operative pain which hindered their demonstrated the neglect of local tourism employees, who ability to do manual work, rendering them and their families have to routinely carry loads ranging from 20 kg to 45 kg on in a worse position financially.16 behalf of the trekkers.11 The study revealed concerns about porter clothing, shelter,
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