Treating Depression Overseas in Expatriates and Nationals

Breakout Session
Main Building ATCR 207/209

Ken Gamble MD FFTM RCPS(Glasg) is the President of Missionary Health Institute in Canada, which specializes in the care of missionaries in all stages of their journey. Formerly serving as medical superintendent of a hospital in KwaZulu-Natal, Dr Gamble joined the MHI staff in 1982. Unwittingly he became a pioneer in the field of travel medicine and has committed his career to the health management of expatriates. Dr. Gamble has served as a longstanding member of the International Health Advisory committee for SIM International and served for eight years on CATMAT, an advisory committee to the Public Health Agency of Canada. Recently he received an honourary fellowship of travel medicine from the University of Glasgow. Dr. Gamble has a keen interest in preventive health, risk management, and telemedicine and has co-authored review articles on expatriate health.

Objectives

In a world of specialization, what could primary care providers contribute to the management of depression in missionaries? Data that help provide a sense of the challenge are thin and wide-ranging. Some have cited that as many as 25% of people applying for a new expatriate position were suffering from depression or another psychological condition. Stress during cross-cultural transitions, expected and unanticipated hardships, are such that 46% of aid workers in one study reported that they had experienced psychological illness of clinical severity. GeoSentinel reported in 2009 that depression, non-mefloquine psychosis, stress, and fatigue were more commonly associated with expatriates when compared with short-term travelers.

Through the lens of a primary care provider, this workshop we will explore:
1) The ‘typical’ mental health profile of applicants for a new expatriate position
2) Common challenges that contribute to psychological illness
3) Preventive and early interventions that may prevent and ameliorate psychological illness