Saipem health training

Health and Occupational

Medicine

Pre-travel
Counselling
HEALTH INFORMATION
FOR SAIPEM EMPLOYEES
TRAVELLING ABROAD

mercoledì 19 maggio 2021

 Pre-travel Counselling
Travelling in the different countries where the company is active and present is a
big opportunity for professional interrelations, both in terms of human and social
relations and in terms of cultural comparisons and exchanges. Lifestyles, ethical
choices, customs and traditions: from food to hygiene habits, adapting to
different climates and environments.
The health information for Saipem employees assigned abroad, on business or on
contract, is called "Pre-travel counselling" and is organised by the company's
Medical Department in compliance with Corporate Procedures and International
Guidelines. Its main objective is to inform workers before departure of potential
health risks in their geographical destination through the transmission of
information, skills and competences likely to facilitate the development of
potential and the improvement of personal resources, facilitating the fulfilment
of needs and behavioural change.

UCSC

Pre-travel counselling activities and all the information

contained within the health information sections were
validated by the Institute of Occupational Medicine of
the UCSC University of Rome UNIVERSITY OF ROME
Institute of Occupational
Medicine
 Table of contents
Chapter 1 Country profile
Chapter 2 Before departure
Chapter 3 Vaccinations
Chapter 4 Hygiene Precautions
Chapter 5 Risks from food and water
Chapter 6 Animal and insect bites

Chapter 7 Risky behaviour

Chapter 8 Psychosocial Risks
Chapter 9 Climate risks
Chapter 10 Pregnancy and children
Chapter 11 Air travel

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Chapter 1
Country profile

4
 TURKEY
Europe/Asia

Capital: Ankara (GMT +2) Altitude: 920 m Surface area: 779,452 km2 Inhabitants:
73,772,988 Infant mortality: 14/1000 Illiteracy rate: 11.3% Religion: Muslims 99.8%
Language: Turkish (official), Arabic, Armenian, Kurdish Climate: mountain,
Mediterranean. The climate in Ankara is continental. The winter is harsh with snow,
ice and temperatures as low as -10 degrees; the summer is hot and dry, with
temperatures around 30-40 degrees and drastic temperature differences between
day and night (altitude 900 metres). In Istanbul the summer is hot and humid, the
winter rainy and humid; Izmir and Antalya have a Mediterranean climate with mild
winters and very hot summers.
Recommended vaccinations: COVID-19 Vaccine. Diphtheria-Tetanus 1 booster dose
if it has been more than 10 years since the last vaccination: vaccine required for
access to the Aegean Refinery Project.
Hepatitis A and B, typhoid fever.
Malaria: There is a risk of malaria, exclusively from P. Vivax, from May to October in
the Amikova region and the Cukurova plain in the south east of the country. There is
no risk of malaria in key tourist areas, the western and south western parts of the
country.
Health advice: Adopt all the necessary precautions while consuming water and
food. Be careful of sexually transmitted diseases. The Country is subject to strong
5
temperature differences. Prevent insect bites.
Aliaga
• a.

6
Aegean Refinery Project

7
 Health issues

Generally, the health situation in the country is satisfactory, although there are
some shortcomings in the infrastructures; some public hospitals are not in good
condition, though the private clinics are generally of a higher standard.

Medical Park Hospital Kent Hospital Aliaga Tip Merkezi

In minor cities some endemic diseases still exist (intestinal infections, hepatitis,
amoebae etc.). In the summer - particularly in south-east Anatolia - take care when
purchasing beverages (the water is not potable) and food to avoid typhus and
gastrointestinal infections which could lead to more serious diseases. Your attention
is also drawn to the risks deriving from the presence of “E coli” bacteria in some
products and packaged foods. In particular, do not purchase minced meat or various
packaged starters and mixed salads.
The last cases of avian influenza (H5N1) were recorded in Turkey in January 2006 by
the WHO (World Health Organisation) in the district of Dogubayazit (Van province),
near the Iranian border. In all cases the sick lived in contact with infected birds. 8
 OUTBREAKS

Coronavirus Disease (COVID-19)

A new coronavirus, first identified in China in December 2019, has caused an
outbreak of respiratory illness that the World Health Organization (WHO) named
COVID-19 in February 2020. On March 11th, WHO declared COVID-19 a pandemic.

Coronaviruses are a large family of respiratory viruses that can cause diseases
ranging from the common cold to the Middle-East Respiratory Syndrome and the
Severe Acute Respiratory Syndrome (SARS).

Common signs of infection include respiratory symptoms, fever, cough, shortness of

breath and breathing difficulties. In more severe cases, infection can cause
pneumonia, severe acute respiratory syndrome, kidney failure and even death.

More information about Coronavirus you can find on dedicated page on Health Portal at link:
http://hsesite.saipemnet.saipem.intranet/Health/Public%20Users/Coronavirus%20disease%20(COVID-19)/Pages/default.aspx
9
 OUTBREAKS

Coronavirus Disease (COVID-19)

The basic principles to reduce the general risk of transmission of coronavirus
(COVID-19) include the following:
• avoiding close contact with people suffering from acute respiratory infections.
• regularly and thoroughly wash your hands
with soap and water or clean your hands with
an alcohol-based hand rub
• maintain at least 1 meter (3 feet) distance
between yourself and other persons
• avoid mass gatherings
• avoid touching eyes, nose and mouth – to
avoid transfer of the virus to your eyes, nose
or mouth, from where the virus can enter
your body
• travelers with symptoms of acute respiratory
infection should practice cough etiquette
(maintain distance, cover coughs and sneezes
with disposable tissues or clothing, and wash
hands) and visit medical doctor immediately. 10
 Before departure
Chapter 2

11
 Before departure

 Be sure to have a copy of your current Medical Fitness

Certificate that was issued after your medical
examination,
 Ensure, by consulting your doctor, that your vaccines
are up-to-date for your country of destination.
 We recommend a full dental examination with your
dentist; (to avoid any problems on-board or on site)
 Make note of the emergency numbers in the
following slide;
 Bring a supply of prescription medication that you
take regularly (medication for hypertension,
diabetes, asthma, etc.,) along with the
prescription in English in your hand luggage.

 TRAVEL ADVICE BEFORE boarding a plane:

Be sure that you have a negative COVID-19
PCR test performed within prescribed time frame.
Health problems during your trip or stay
Emergency Card

MEDICAL ASSISTANCE
Saipem’s “Pronto Dottore” Service

In case of health problems abroad and

only in the absence of Saipem
on site medical service
please contact the 24/7
Saipem’s “Pronto Dottore” Service
+39 02 44234777
Saipem also has an agreement with europ assistance
to manage Health Emergencies and Advices 24/7 call
+33 170700911 identifying yourself as a Saipem employee
 Medical repatriation
Medical Evacuation (MEDEVAC)

In the event of an illness or injury that requires medical repatriation, Saipem

will organize travel home for the employee or, if necessary, to the hospital
closest to their home.

After a medical repatriation, or in any case, after a serious illness the employee
must have another medical examination to ensure fitness to return to duties or
the specific destination.
Chapter 3
Vaccinations

15
 Recommended vaccinations

COVID-19 Vaccine

The vaccination process, presently

exclusively under local governments’
organization and responsibility, is
going on all around the world with
different timing and priorities
settings.
Regulatory agencies in each country
are in charge for approving the type
of vaccine to be used locally.
Therefore, the availability of
vaccine may differ from country to
country.
Although recommending vaccination against COVID19, Saipem does not advocate for
any type or brand of vaccine. This is left to local authorities and individual’s choice.

For further info please access:

http://hsesite.saipemnet.saipem.intranet/Health/Public%20Users/Coronavirus%20disease%20(
16
COVID-19)/Pages/default.aspx
 Recommended vaccinations
Hepatitis A
This is an acute infectious disease
that affects the liver. It is found
globally, especially in Central
America, South America, Africa,
The Middle East, Asia and The
Indo-Pacific. Cases are diagnosed
among travellers that use
facilities (hotels, restaurants or
food stalls) that do not comply
with even the most basic food
hygiene regulations.
The disease is spread by eating or
drinking contaminated food and water,
especially frozen berries, vegetables
and undercooked or raw shellfish.
Vaccinations: Two doses. 1 dose before departure and 1 booster
dose 6-12 months later; Protection lasts a lifetime; Vaccine
effectiveness: very high (94-100%).
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 Recommended vaccinations
Hepatitis B
This is an infectious disease that affects the
liver. It can develop into cirrhosis, liver
failure and liver cancer.
Transmission can occur due to even minimal
exposure to blood through direct
percutaneous, intravenous, intramuscular,
subcutaneous or intradermal contact
(tattoos and piercings); or from exposure
to body fluids during sexual intercourse

Vaccinations: Three doses. The first two doses 1 month apart;

One booster dose 6 months after the second dose; Protection lasts a lifetime;
Vaccine effectiveness: very high (95%).
 Recommended vaccinations

Tetanus: is caused by a toxin released by a bacteria present in our environment

which enters the skin through the slightest cut or wound.
Diphtheria: transmitted via a toxin carried by saliva
The vaccines for Tetanus and Diphtheria are usually combined and so that their
doses and schedules are the same
3 doses of the combined vaccine are given starting with the initial dose (day zero),
1 booster dose after 6-8 weeks from the initial dose and a second booster dose 6-12
months after the first booster. A booster is necessary after 10 years.
The vaccine is effective in preventing tetanus after the cycle has been completed in
almost 100 % of all cases.

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 Recommended vaccinations

Typhoid fever: Transmitted by feces. Infection may be direct, from unwashed hands
(less frequent), or indirect, by eating or drinking food (vegetables, milk, meat,
shellfish or eggs) or water contaminated with feces.
The vaccine 1 injection 15 days before travelling or 3 pills taken every other day;
Protection lasts: 3 years; Vaccine effectiveness: from 75 to 80%.

Source: The global burden of typhoid fever. Bulletin of the World Health Organization
 Recommended vaccinations

Meningococcal meningitis:
is transmitted via human to human contact through food and/or saliva.
The bacterial form is much
rarer but much more dangerous
than the viral form and can be B-C
fatal. Vaccination is B-C-Y
A-B-C
recommended for anyone, of
any age, that will be going to
areas where the disease is
endemic during the period of B-C A - W135 - C - Y

seasonal transmission and who B-C

will be in contact with the B
local population. Global Serotype Distribution

Vaccines:
 Trivalent meningococcal vaccine protects against meningitis caused by
meningococcal serotypes (A, C, W-135, Y), the most common in Africa.
Usually a single dose is enough, without the need for boosters.
 Vaccine against serotype B, two doses (one month apart)
 Seasonal flu and H1N1

Hygiene and individual protection measures

Human transmission of the flu virus occurs through tiny droplets made when
someone coughs or sneezes. Transmission can also occur through contact with
someone's hands that have these droplets on them. For this reason, good hygiene
(washing your hands, covering your mouth and nose when you sneeze or cough) can
play an important role in limiting flu transmission.
The flu vaccine is an effective and sure method to prevent seasonal flu, H1N1, and
complications.

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Chapter 4
Hygiene Precautions

23
Invisible traces of blood, saliva, mucus,
vomit, urine or feces may be left,
unintentionally, on light switches,
handrails, banknotes, etc. If we touch
those surfaces and then touch our eyes,
nose or mouth directly, or indirectly via
our cell phone or coffee cup, then we too
become contaminated.
Think about that every time you walk
into a public restroom or crowded room.
Therefore:
 Always wash your hands before
eating. Wash your hands frequently
if you travel or work in crowded
environments;
 Where possible it is preferable to
use soap and water or, as an
alternative, hand sanitizer ;
 Dry your hands well and use the
towel to turn off the tap.
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 Risks from food and water
Chapter 5

25
Outside of Saipem locations, we recommend that you be very careful with food and
water (both for consumption and hygiene), because they can be potential sources of
disease like: traveller's diarrhoea, typhoid fever, cholera, amoebiasis, hepatitis A.
Ask your colleagues which bars and restaurants are safe.
SAFE FOODS FOOD TO AVOID

Packaged milk Beverages Home-made ice-cream

with ice
"Dry" foods (bread, biscuits, etc.) Sauces and cold creams
Sealed bottled water and
Home-made beverages Street
beverages
(preferably carbonated) food

Beverages in cups Wild game

only if boiled!

Foods Cold
Well cooked eggs Salads
served foods
Well done meat hot
Raw or barely cooked foods

Canned foods Peeled

Unwashed
(check expiry fruit
fruits and
dates) vegetables
 Healthy Diet
The calorie content of your diet should correspond to your actual daily needs.
The consumption of animal fats should be drastically reduced; vegetable fats can
be consumed in moderation with a preference for monounsaturated fats (extra
virgin olive oil). You should limit your intake of salt and sugars and foods
containing them (cold lunch meats, sweets and carbonated beverages).
Ask the site doctor for support. Attention: Pathological conditions caused by
improper diet (obesity, dysmetabolic syndrome, etc.) can lead to the issuance
of Medical Fitness Certificate with restrictions for the job or the specific
destination. Where possible use the gyms and sports facilities available locally.

USE
Gym facilities

* Sugary drinks are major contributor to

AVOID obesity and diabetes. They contain added
Sugary Drinks* sugar, corn or fruit-juice concentrates and
include carbonates, fruit drinks, sports drinks,
energy and vitamin water drinks, sweetened
iced tea, and lemonade.
Swimming in streams
and rivers can expose The mud and sand
you to parasitic may be home to Do not forget that
diseases such as parasite larvae or drowning is the greatest
schistosomiasis may hide sharp or risk when swimming:
(bilharzia or snail dangerous objects:
fever), leptospirosis Be aware of currents and
avoid walking
and forms of water temperatures - do
barefoot or with
diarrhoea. not swim in unsupervised
shoes that offer
waters and always tell
We recommend that little or no
someone when and
you avoid swimming protection.
where you plan on
in not controlled
entering the water.
waters.

mercoledì 19 maggio 2021 28

 Animal and insect bites
Chapter 6

29
30
 General rules and precautions

 Never tease animals

 Do not dig through sand with your hands, there may be poisonous animals or
dangerous objects under the surface
 In heavily wooded areas wear closed shoes and long trousers (tuck pant legs
into socks or tighten around ankles) and stamp your feet when walking (to make
noise)
 Never swat insects that land on your skin, use specific repellents
 Particularly in central and eastern Anatolia, over the past few years some cases
of haemorrhagic fever have been reported, many of which were fatal, caused by
tick bits.
 In the event of bites or stings see the site doctor immediately

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 Insect repellents

Insect repellents, available on-site, can vary in their effectiveness depending

on the type of insect. Follow instructions on the package carefully:

 Apply only to exposed skin. Do not apply over

cuts, wounds, or irritated skin. Do not apply
directly to your face. Do not use under clothing;
 The protection times listed rarely correspond to
actual protection. Protection times are affected
by different variables including:
rubbing, sweating which dilutes the repellent and temperature;
 After returning indoors, wash treated skin with soap and water;
 If you have an allergic reaction to the repellent, wash the treated skin with
soap and water, and refer to the doctor.
The concentration of the main active ingredient as established by the Italian
Istituto Superiore di Sanità (ISS) for use in areas where malaria is a risk, is:
DEET at 30% or Icaridin KBR at 20%. Lower concentrations are still effective but
require more frequent application.
 Rabies prevention
Rabies is present on all continents, with the exception of Antarctica,
but over 95% of human deaths from the disease occur in Asia and Africa:
55,000 people die from Rabies every year (WHO 2012)
The greatest risk to travellers are dogs (and to a lesser extent, cats), but do not
forget the risk from wild animals (e.g. foxes and bats). Avoid contact with wild
animals and if you are bitten or scratched go to the closest Emergency Room to
receive the rabies vaccine and treatment

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Source: WHO
Malaria

34
 Malaria
In 2019:
 malaria killed about 409,000 persons
 229 million persons were infected by malaria
 91 countries and areas were currently endemic, visited by more than 125 million
international travelers
 Approximately 40% of the world’s population is at risk of contracting malaria

Malaria can cause PERMANENT COMPLICATIONS involving multiple body organs &
DEATH.

35
Malaria
symptoms Even if a rigorous
prophylaxis has been
followed,
CONSIDER THE POSSIBILITY
OF HAVING CONTRACTED
MALARIA.
In case of sudden increase in
temperature, shivers,
migraine, vomiting and
diarrhoea, within 7/9 days
of arrival in the risky area,
up to several weeks after
returning home,
go to the nearest Saipem
medical centre or to the ER
in your country
36
 Malaria
prophylaxis

Environmental preventative measures: prevent the survival of

mosquitoes. Through the periodic fumigation of environments,
use of air-conditioning systems and mosquito nets in all indoor
environments (accommodation, restaurant, offices...)
Mechanical preventative measures: prevent mosquito bites.
By wearing long-sleeved shirts and long trousers from sunset
to dawn, Applying insect repellents (30% DEET or 20% Icaridin
KBR) on all exposed body parts and Staying in air-conditioned
environments.
 Insect repellents
Insect repellents, available on-site, can vary in their effectiveness depending
on the type of insect. Follow instructions on the package carefully:
 Apply only to exposed skin. Do not apply over cuts,
wounds, or irritated skin. Do not apply directly to
your face. Do not use under clothing;
 The protection times listed rarely correspond to
actual protection. The protection is affected by different variables including:
rubbing, sweating which dilutes the repellent and temperature.
 After returning indoors, wash treated skin with soap and water.
 If you have an allergic reaction to the repellent, wash the treated skin with
soap and water.
The concentration of the main active ingredient as established by the Italian
Istituto Superiore di Sanità (ISS) for use in areas where malaria is a risk, is: DEET
at 30% or Icaridin KBR at 20%. Lower concentrations are still effective but require
more frequent application
Measures that cannot be recommended for repelling insects: Bath oil;
Citronella oil-based repellents (these have very short durations of action); Citrosa
plant (geranium); Garlic: fresh or capsules; Vitamin B12 complex; Yeast extract
spread; Electronic (ultrasonic) buzzer devices; Vitamin B1 tablets; Tea tree oil.
 Dengue Fever
Chikungunya and Zika

39
 Dengue Fever, Chikungunya Fever and Zika Virus
Aetiology

Dengue, Chikungunya and Zika are widespread in tropical and sub-tropical areas,
and are caused by viruses transmitted by mosquito (Aedes) day biting.
Worldwide the cases of Dengue Fever, Zika and Chikungunya are steadily
increasing. The period in which the risk of contracting the disease is higher during
the wet season.
About Dengue there are four
different virus serotypes (DENV-
1, DENV-2, DENV-3, DENV-4)
and, generally, being infected
with a different serotype
entails a higher risk of serious
complications.
The most common forms manifest
after a latency period of: 5-8 days for Dengue and 3-12 days for Chikungunya and
Zika. The patient suddenly suffers from high fever (sudden-onset fever), shivers,
migraines, muscular cramps and severe joint pain (Chikungunya = “contorting”). In
certain cases, the infection can be asymptomatic and go unnoticed.
 Dengue, Chikungunya and Zika
Preventative measures and treatment

As for Malaria, the most effective preventative measure against these diseases, is
to avoid contact with virus-bearing mosquitoes, mainly active early in the
morning: use of repellents, protective garments, and periodic fumigation of the
environments are strongly recommended.
WHO: «There is scientific consensus
that Zika virus is a cause of Guillain-
Barré and microcephaly syndrome» in
particular registered among newborns Zika transmission
in South America. Pregnant women are
advised not to travel in the Countries with active local Zika
transmission: Central and South America, The Caribbean and The Pacific Islands.
Against these virus there is no specific therapy; current treatment includes absolute
rest, use of medication to lower the fever (avoid aspirin) and drinking liquids to
contrast dehydration. Early diagnosis and access to treatment are essential.
Dengue, for which a series of Stage III (advanced) vaccines are being developed, can
evolves as «haemorrhagic» forms.
In case of fever, especially when accompanied by joint pain, immediately refer
to the Saipem medical service or, after returning home, to the nearest ER.
 Risky behaviour
Chapter 7

42
 Local Culture
Turkey is a country with an Islamic majority. Religion has a very important role in
day-to-day life. Please be respectful of the rules that Muslims must adhere to during
Ramadan by abstaining from eating, drinking or smoking in public from dawn until
sunset.
Please dress and behave modestly, so as not to offend local sensibilities. Some
food items and beverages are prohibited. Publicly insulting the religion, sacred
texts and religious figures is punishable by law and may provoke violent reactions
from the public.
We recommend to always respect different cultural and religious expression and
the different social systems related to the context where you are currently
working.

43
 Culture Etiquette and Law Essentials

The use of illegal drugs is prohibited. Penalties for possession, use or trafficking of
illegal drugs are strict.
It is illegal to denigrate, desecrate or insult the following:
• the name or image of Mustafa Kemal Atatürk, the founder of the Republic of Turkey
• the president of the Republic of Turkey
• the Turkish flag and the national anthem
• Turkish currency
• State organs and institutions and its judicial bodies
• the police and the military
 Culture Etiquette and Law Essentials
• Turkish antiquities and other cultural artifacts that are considered of historical
value or of national importance cannot be exported.
• Avoid physical contact, including holding hands, in public.
• Avoid discussions (including in social media) on historical and religious issues as
well as on politics. Turkish authorities have detained and prosecuted large
numbers of people over social media posts criticizing the government, state
officials, president, military operations—even when the posts were published in
the past or while the author was in another country.
 STD - Sexually Transmitted Diseases
￭ Every year there are over 340 million new cases of
sexually transmitted diseases. Bacterial or protozoan
infections occur all over the word, every year. Given social,
demographic and migratory tendencies, the population at
risk of sexually transmitted disease is likely to increase;
￭ STDs are widespread diseases but the rate of infection is
particularly high in developing countries where these types
of infections and their complications are among the top
five reasons why adults seek medical assistance;
￭ The most common sexually transmitted diseases are:
hepatitis B, HIV, syphilis, gonorrhoea and chlamydia;
￭ Some STDs become chronic and have a less favourable
prognosis (HIV, Hepatitis B). Others that can be cured but
are very contagious and can have complications, can
cause inflammation, neurological syndromes, infertility and
even cancer;
￭ Among preventable illness, STDs infections are the main
cause of infertility. HRO –Health & Occupational Medicine
 STD - Sexually Transmitted Diseases
Prevention
￭ The first form of prevention is to avoid risky sexual
behaviour;
￭ The most effective way to prevent Hepatitis B is the
vaccine;
￭ Latex condoms are the most effective way to prevent
STDs if worn before sexual intercourse begins. This
includes vaginal, anal and oral sex;
Early Diagnosis
￭ Travellers that have indulged in risky sexual behaviour
must see a doctor when they return. This is in their own
best interest as well as in the best interest of current and
future partners.
Anyone who commits criminal acts against minors while
abroad (sexual abuse, exploitation, prostitution), in
addition to being subject to severe, local law, will be
persecuted according to current law upon returning to
their country of origin.
 A reminder for those who choose to get
Tattoos or Piercings
The procedures that require the use of needles and sharp instruments carry
the risk of transmitting bloodborne pathogens as well as serious skin
infections, if prevention and hygiene precautions are not scrupulously applied:
 Did you know that getting a tattoo means introducing various types of ink into your skin?
 Did you know that it is permanent and that to have it removed requires plastic surgery?
Did you seek advice from someone older than you?
 Did you know that by getting a tattoo or a piercing you could be subject to different
infectious diseases, such as hepatitis and AIDS?
 Did you know that the risk of infectious disease is greatly reduced or eliminated if the
operator applies fundamental hygiene, disinfection and sterilisation rules?
 Do you have a skin condition? If so, see your doctor before getting a tattoo or piercing
 Did you know that it is possible to be or become allergic to ink or metals?
 Have you fully understood the risks that you are exposing yourself to?

48
 Drugs and Alcohol

As set forth by Saipem policy and by local authorities, the company is committed
to guaranteeing a safe and healthy work environment and is aware of the fact that
the use of drugs and alcohol can have detrimental effects on the health and safety
of an individual and on colleagues. Use, possession, distribution and sale of
narcotics is strictly forbidden.
The company, in agreement and
compliance with local laws and
legislation, can decide to carry out
individual alcohol and drug testing
whenever necessary. Tests will be carried
out fully respecting an individual's dignity
and results will be processed respecting
everyone's privacy. Non-compliance with
Saipem policy and local laws can result in
disciplinary action, in accordance with
current legislation and regulations in the
applicable collective agreement.

49
 Driving Safely
Road accidents are a public health issue that is still too often neglected. They
represent the ninth cause of death among adults. It is estimated that, without
adequate countermeasures, within 2020 they will become the third global cause of
death and disabilities in the world. WHO - Global status report on road safety

The main causes of road accidents, such as RTAs (ROAD TRAFFIC ACCIDENTS REPORTED) are:

• Travelling over the speed limit at speeds not suitable to the road surface;
• Disregard / lack of knowledge of local traffic laws;
• Distracted driving, over confidence, fatigue;
• Vehicles in bad condition (worn tyres, poor maintenance, etc.);
• Adverse weather conditions;
• Using cell phones while driving;
• Errors committed by other drivers.
• Drive only when absolutely necessary;
• Do not speed and do not allow others to do so;
• Use hands free devices to make telephone calls;
• Always wear a seatbelt, both in the front and back seats.
• Do not drink and drive and do not allow others to do so;
50
• Do not smoke while driving;
 Security
Due to the political and social situation in the country, Saipem advises its workers
to scrupulously observe Security procedures, which for some destinations involve
restrictions

￭ Scrupulously observe the laws in force.

￭ Keep a low profile when travelling; do not draw attention by wearing or using
valuable items.
￭ Be sure to always tell someone where you are going; during your stay, do not
participate in political rallies or demonstrations and do not go near the interested
areas; keep abreast on how the situation in the Country is evolving.
￭ Do not take photos or film in the airports, barracks, government offices, etc.;
 Psychosocial Risks
Chapter 8

52
 Psychosocial Risks
Your roots
Expatriation can be a very enriching experience which must be carefully prepared
for in order to avoid some pitfalls that could be very harmful.
Take care of your roots, do not let them perish

What are your Roots?

 your family,
 your friends,
 your hobbies.

How do you care for

them?
COMMUNICATE!!!
 by phone,
 by writing,
 by letting people know what you are doing and keeping in touch with your
network and not losing touch with your daily routine.

DO NOT LET YOUR ROOTS PERISH THEY ARE YOUR LIFE FORCE 53
 Stress
Stress is a little bit like Cholesterol, there is « GOOD » and « BAD » stress.
« GOOD » stress stimulates while « BAD » stress destroys.
« GOOD » stress comes from within. When a person wants to challenge themselves
to reach their objectives by improving their performance.
« BAD » stress is imposed by others. When a person who knows their limits, is
forced to exceed them to reach objectives that are, in their opinion,
unachievable.

The way we think alters the way in which a particular type of stress affects us.
What is stressful to one individual may not be to another. What is stressful to an
individual today may not be tomorrow.
Distress is related to the perception of loss of control that results from a perceived
imbalance between the pressures being exerted and the resources of the
individual.
54
 Climate risks
Chapter 9

55
 Climate

There are three distinct climates in Turkey: on the Mediterranean coast summers
can be very hot and the winters are mild, with rain that may become heavy on the
Taurus mountains which are affected by humid currents, while other areas have a
clearly sub-tropical climate.

There is a great difference between the coastal regions and those inland at
higher altitudes. The climate is more extreme in Central and Eastern Anatolia,
with hot summers with temperatures reaching 42oC, and cold winters with snow
due to the high altitudes; rain falls in the spring and autumn. The temperature
56
in Ankara varies from -4ºC to 30ºC;
 General recommendations

 Remember that the human body needs time to adjust, depending on health
conditions and age: so...
 Adapt the way you dress to local weather conditions; wear light-coloured long-
sleeved shirts and long cotton trousers; wear a hat; protect your eyes with
sunglasses and, when you are exposed to the sun for extended periods of time, use
solar creams with high protection factors
 Drink up to 2 litres of bottled water every day; in case of excessive perspiration it
may be necessary to drink up to 6 litres of water every day.
 Observe Saipem policy by abstaining from alcohol on all sites and under all
weather and atmospheric conditions

Be careful when leaving air conditioned environments due to the drastic

temperature changes
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Chapter 10
Pregnancy and children

58
Any trip and stay abroad and What to do if ...
related vaccines (and
antimalarial chemoprophylaxis)
must take pregnancy into
consideration and be approved
by your gynaecologist.
Air travel is not recommended
after the 8th month (airlines
will not allow women to fly in
their last month of pregnancy).
The ideal period is between the
16th and 28th weeks.
 Children
Comfort & Safety: Children are far more
susceptible to temperature changes;
Diarrhoea and Dehydration: It is essential to
ensure that children drink enough good
quality water, that they follow good hygiene
rules and that they are suitably protected
from the sun and wind;
Animal and insect bite prevention: Children
are easily attracted to animals (whether
domestic, wild or exotic, like monkeys).
These animals may transmit bacteria, viruses
or parasites;
Immunization: ensure, together with your
paediatrician, that children have received all
required vaccines and medication required
for the specific risks associated with your
destination;
60
Chapter 11
Air travel

61
 Problems with cabin pressure
Dry cabin air causes dehydration.
To combat this it is necessary to drink a lot of liquids and to avoid alcohol.
If you are subject to "air sickness" do not drink tea or coffee (they irritate your
stomach) or carbonated beverages (including beer). Carbonated beverages should
be avoided because, due to the way gases react to atmospheric pressure, dilating
more under lower pressure. This means that the bubbles in the drinks at ground
level will dilate in flight, adapting to cabin pressure, causing bloating and
meteorism.
Changes in pressure during landing can cause earache
which, in some cases can result in inflammation.
It can be particularly bad if you have a cold. In
most cases you can find relief by swallowing,
Chewing or yawning. If the problem persists
you can try forceful exhalation against a
closed airway, usually done by closing
one's mouth, pinching one's nose shut
(Valsalva manoeuvre).

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 In Flight Problems

Motion sickness: Never fly on an empty stomach. Contrary to what you may think, it
makes air sickness worse. Travellers that are affected by air sickness may also be
subject to headache, nausea, excessive perspiration and dizziness. To reduce these
ailments, ask to be seated on the aisle close to the wings. The seats over wings feel
the least amount of motion during flight. Before flying and during the flight we
recommend that you eat light snacks like fruit and vegetables. Avoid coffee, tea,
alcohol, nicotine and fatty or spicy foods. You can use over-the-counter motion
sickness medication such as specific chewing-gums or pills, that reduce motion
sickness.

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 In Flight Problems

Swelling: Remaining seated without moving for long periods of time, as happens
on an aeroplane, reduces blood flow to the heart that normally occurs with
movement. This may cause water retention, especially in the lower limbs. Move
as much as possible. Walking up and down the aisle, standing for short periods
and doing some light stretches while in your seat will help to reduce swelling in
your legs and feet. Wear comfortable shoes that are not tight around your ankles,
avoid crossing your legs during the flight, get up often and stretch your legs in the
aisle, doing the recommended exercises as much as you can. Those that are in
high risk categories (obesity, diabetes, etc.,) should wear compression socks.

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 Effects of jet lag

Moving quickly to a location with a different time zone will cause a change in your
body's daily rhythm.
Not only does it disrupt the normal sleep-wake
cycle, but it also interferes with the smooth
running of many other functions that are set to
24-hour cycles. To combat the effects of jet
lag, it is advisable to sleep well the night
before the flight and, if your stay at the
destination does not exceed two days, keep
your physiological clock set to home time. For
longer stays, however, it is advisable to adhere
to a healthy lifestyle to adapt to the local time
as quickly as possible taking into account that
you will typically recover from jet lag faster if
you travel westward.
Once on board the aircraft adjust your watch to the time of destination: this will
help you to adapt mentally to different daily rhythm that awaits you. Avoid taking
sleeping pills because it would only confuse the body even more and induce an
unnatural "stillness" and slowdown the bloodstream.
 Saipem «Si Viaggiare» app

All the information found in this

country presentation, and any further
details on the topics covered, are
available in the Saipem Health Manual
for International Travellers with the «Si
Viaggiare» app from the company
Travel Medicine service, which can be
downloaded on your devices
(smartphone, PC and tablet),
Apple, Android and Windows.

http://www.saipem.com/sites/SAIPEM_en_IT/minisiti/saipem-app-en.shtml

66
 Source
References and Updates
This country presentation was prepared using the guidelines expressed,
to the best of their responsibilities, by the following institutional
bodies, healthcare organizations and industries.
The health information contained therein is updated in real time thanks
to Health Surveillance services through email alerts and RSS.

If you should have any questions or require further information please contact the Saipem
Health and Occupational Medicine Unit at travelmedicine@saipem.com
or the site doctor upon arrival.

Visit Saipem Health Portal at: http://hsesite.saipemnet.saipem.intranet/Health/Pages/default.aspx

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updated by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect
every presentation of a condition. The information contained on these pages and in any third party websites referred to
on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for
medical diagnosis or treatment.