Choose Your Location with Your Health in Mind
In deciding where to study, work, or volunteer abroad, you'll consider intellectual interests, career goals, personal passions, finances, special opportunities-and health considerations specific to you and to that place. You have to be honest with yourself about all these issues, health included.
STEP 1: Consider your Health Issues as You Make Choices
QUESTIONS TO ASK YOURSELF
- Do you have allergies that could demand immediate treatment?
- Are you a regular member of a health program—AA or another self-help or therapeutic group, perhaps?
- How much risk are you willing and able to deal with in a given day?
- Do you like being by yourself or in a small town? Or do you prefer a city with lots of activity, noise, and people?
- Will you be comfortable with the daily physical challenges of some locations, like climbing a mountain or crossing a body of water by boat? (For many, the most commonly faced challenge will be lots of walking, far more than in the U.S.)
- If you have a disability, does it have health-related implications that can be affected by access to medical supplies or health facilities, and schedule or climate changes abroad?
- Are you in an on-going counseling program that will continue while abroad? Some countries provide less access to counseling than others.
QUESTIONS ABOUT YOUR FAMILY
- How will your family respond to your being abroad for a long period of time? Will they be excited for you? Will they worry about you? Have they traveled? Or will this be scary for them because you are the first in your family or community to go overseas? Will their worry cause YOU stress?
- How can you communicate your enthusiasm and confidence to them to relieve their fear and reduce your stress?
- Once overseas, will you be able to communicate with them as easily and often as you expect to?
- Does anyone in your family have health issues you will be anxious about while overseas? (Insurance is sometimes available to help cover the return fare home in case of a family medical emergency.)
Talk with your program adviser about health needs and questions.
As you pull together your specific concerns, share them with your on campus education abroad (ed-abroad) adviser-the person to start with for advice on where to go and how to deal with special health issues, physical and mental. The conversations are confidential (the Family Educational Rights and Privacy Act-FERPA-only allows information sharing from such conversations on a "need-to-know" basis), so don't hesitate to voice any fears or worries about your health. Education abroad advisers are experienced professionals who can point you to programs and destinations that suit you-programs and destinations you might never find on your own. And if you have special health needs, they can direct you to the information you need about the local medical care, services, and self-help groups at a chosen destination.
Be open and honest about health on your application.
If you have any health issue, psychological or physical, be clear about it from the beginning. Many ed-abroad programs ask for health information once you have been accepted. This information request is not to exclude you but to be sure that they-and support people at your chosen destination-can provide what you need . For example, they need to know if you are allergic to some animal pets so you don't get placed with a family that has them. They need to know if you are undergoing psychological or any physical treatment that will affect you overseas, or if you routinely require certain types of medication. Many programs abroad require health examinations before you depart. Take advantage of that appointment with your primary health care provider and ask any questions you have about your health and your overseas destination. Being honest can be the best insurance policy.
IF YOU ARE A STUDENT WITH DISABILITIES,
Verify at the very start, even before the application process, that adequate facilities and personnel are in place and that your needs can be met at your study abroad destination. You can contact the National Clearinghouse on Disability and Exchange (NCDE) at Mobility International USA (http://www.miusa.org), a nonprofit organization that provides international exchange resources and strategies for those with health or other questions related to disabilities, for information.
STEP 2: Find Experts and Resources Before You Go Abroad
What do you need to know in health planning for your sojourn abroad? You need to know your own body and its special needs. And, you need to know where you're going and the special health issues (if any) in that region of the world.
Depending on where you go, health care practices and facilities may be similar to or very different from those you know at home. Some geographic regions present their own special health challenges that you must know about and plan for before you leave home. You also need to plan for other places you might travel, not just your primary destination.
Do a little research now, while still at home, for the information to have with you should you need it. No matter where you are traveling to, you need to think ahead.
Start by finding experts on travel health in your own Community.
First, get to know the resources of your college or university. The education abroad office, student health service, and student counseling office can have important allies. If your university has a medical school (or if there is one near you), ask if the faculty includes any experts on international health. Or look for an international health counseling center to get up-to-date information on immunizations and health advisories. Public health agencies provide some of these services, and they may also administer many of the necessary inoculations. Ask your family physician for a referral. The Centers for Disease Control Web site has links to medical organizations with directories of private travel clinics throughout the United States (see the Travel Health Resources section at the end of this guide).
Find out which vaccinations are indicated-both the recommended and the required-for the country or countries where you are headed.
The earlier you know, the better, because some involve a series of shots over time. Other vaccines, not officially required, may be advisable to prevent serious diseases while traveling, e.g. hepatitis A, hepatitis B, typhoid fever, and others. Ask your health care provider for advice on these. Once you have the list of required shots, make an appointment at student health, your doctor's office, the public health service, or the office of your medical travel specialist to start getting them.
IF AT ALL POSSIBLE, visit the CDC site along with a health professional because its language is often medically technical.
STEP 3: Research Your Destination
EVERY WORLD REGION-the U.S. included-presents its own opportunities and challenges for staying safe and healthy. It's your responsibility to think ahead and collect whatever information is available in the United States about the particular places where you will be living and traveling. You can start by researching on your own with Web sites like those below, and also consult with any travel health experts at school or home. Two useful government Web sites for travelers and health are worth getting to know:
- The U.S. Department of State has an International Travel Web site that constantly updates travel, health, and security information (http://www.travel.state.gov/travel). You'll find links for current medical information and warnings, together with other advice on traveling abroad. This information is also available by phone from within the U.S. (888.407.4747).
- The Centers for Disease Control (CDC) maintains a Travelers Health Web site (http://www.cdc.gov/travel) that is also constantly updated, providing health information and special warnings about health risks. It has a search feature where you can research region-specific health information. CDC maintains a travelers' hotline, accessible by phone from within the United States (1.877.FYI.TRIP or 1.877-394·8747).
The CDC Web site also has a country-by-country list of required and recommended immunizations—essential information for every traveler. Many countries will not grant you entry unless you have proof of required immunizations.
WITH ALL THE INFORMATION available to you in the United States, all it takes is a little thinking ahead to do your health plan before you go. Use all the resources you can find. Don't be embarrassed to ask every question you can think of! Think how much more difficult, or embarrassing it could be if an issue surfaces later.
Some areas of the world present special health issues. Reviewing this list can help you anticipate the challenges that your chosen destination may present.
Are there special medical requirements for admission to your destination country, or others you will travel through? Many countries have very strict health or immunization requirements, and your entry into any of them may be delayed or even denied if you don't meet them. Some countries have different prescription drug standards than here in the United States-for example, exclusions or special requirements about Ritalin. Be sure you verify such requirements for all the countries you'll travel to/through.
NOTE THAT PREGNANT WOMEN, people with cancer, or people with diseases that compromise their immunity may receive different recommendations than everyone else.
Are there regional diseases that you should learn about and prepare for? Absolutely! Although travelers often have no problems and many locations present few challenges, you need to know that there are some common or serious diseases in different parts of the world today.
DIARRHEA—Many travelers encounter diarrhea, particularly while in the developing world. Although readily treated mild forms can be uncomfortable, severe dysentery can be serious. Always take an antidiarrheal medication with you no matter where you are traveling. Your physician can tell you which one is appropriate for you.
MALARIA AND OTHER INSECT-BORNE DISEASES—Malaria is still a threat in some tropical regions in Africa, Asia, Oceania, Central America, and South America despite increased community efforts to fight it. If you are going to or traveling overnight through an area with malaria, consult your physician or health service about whether to take a program of anti-malarial medication before and after your travel. Learn about this disease, how it is transmitted, and what you can do to avoid it.
HIV/AIDS AND OTHER STDS—There are world regions where AIDS is known to be prevalent. Learn how to handle injections, emergencies, and blood transfusions before you leave home. Make informed judgments about your sexual choices everywhere to avoid sexually transmitted diseases (STDs). Visit the CDC Web site for extensive information.
HEPATITIS OR CHOLERA—These can be risks in some countries, and especially those with untreated drinking water. Learn what your options are for securing safe water and foods.
YELLOW FEVER—A yellow fever vaccine may be required for entry into and travel through many countries in sub-Saharan Africa and equatorial Latin America. Determine whether you need this vaccine well in advance of traveling.
TUBERCULOSIS—Tuberculosis (TB) is prevalent today in some regions of the world. If you think you will be visiting areas where TB is known to be common, be sure to have a TB skin test both before and after traveling.
SUNBURN, ALTITUDE SICKNESS-Different latitudes and altitudes can cause serious health problems. Read and become aware of the potential risks of either in the country where you will be living. Plan ahead, as you both pack your health care kit and plan your first weeks in your new home.
Although many of the diseases and conditions listed above can be gravely serious, it's important to recognize-and to advise your parents-that health risks are not always dramatically greater in developing countries than in the United States, provided travelers are aware of the risks ahead of time and stay alert while abroad. Likewise, health care in some foreign countries may be better in quality than what you might get at home. Becoming aware and then staying alert-a balanced approach-is really the best plan.
Sometimes other/unexpected health risks can pop up, e.g., SARS outbreaks or concerns about avian flu. Remember that the CDC Web site maintains up-to-date information on travel health advisories, so check back as your travel date approaches, as well as while you are abroad.
STEP 4: Collect Essential Info for Safekeeping
Now that you've decided on the challenges of living and adapting to different ways of life in a foreign country-a personal adventure and exploration-assume that you are the most important person taking care of you. And taking care of you includes planning ahead while at home, where you can collect much of the information you'll want now, and need to keep with you while you're abroad.
LOCATION OF THE NEAREST U.S. EMBASSY—Consular officers in U.S. embassies help U.S. citizens abroad. You and your family at home should know beforehand the nearest U.S. consuls. Visit the U.S. Department of State Web site (http://travel.state.gov/traveljtips/embassiesjembassies_1214.htm) to find their contact information. Now you can register online with a local embassy or consulate through its Web site.
AVAILABILITY OF EVERYDAY SUPPLIES—While resources may be widely available, find out how available and costly personal health items will be where you're going, especially if you "just have to have" your favorite brand. Think about over-the-counter and prescription drugs, as well as toiletry items, feminine hygiene products, contact lens solution, and other health-related supplies.
DIET AND EATING PATTERNS—Learn about and be prepared for possible changes to your diet and eating habits. If you use nutritional supplements, find out if they will be locally available or whether you should bring them along.
LOCAL LAWS ABOUT MEDICATIONS—Know your destination's laws regulating the import and possession of all medications (prescription and over-the-counter), hypodermic needles and syringes, and condoms and other contraceptives.
HEALTH CARE DELIVERY SYSTEMS—Get information about health care practices where you'll be studying. Ask how patients are likely to be treated, what kinds of facilities will be there, how payments are handled, and what legal rights you will have to get services while there. It's far better to have the answers beforehand.
PHARMACIES ABROAD—The role and responsibilities of pharmacies-and the availability of prescription drugs-differ from country to country. Learn what to expect of local pharmacists, where to go, and what documentation you'll need to show if you need prescribed medications.
EMERGENCY PROCEDURES—Familiarize yourself, before you leave home, with the emergency procedures of your destination. Some countries have systems similar to 911-learn if there is one in place there before you leave the U.S.
FAMILY CONTACT INFO—Leave relevant contact information with family members, and provide updated information when you arrive at your new home. If you have special health issues, talk with a family member ahead of time about how you will be managing them.
TEP 5: Be Sure That Health Insurance Covers You
One way or another, you should carry health Insurance that covers you while traveling to and while living where you will be studying. Also consider evacuation insurance to cover your return home should a serious illness or accident occur while abroad.
First check to see if your ed-abroad program provides or offers health and accident coverage, and other relevant insurances. Also check with your family or school health insurance companies to see if existing policies cover you while overseas. If the coverage is inadequate or incomplete, look at buying specialty short-termed-abroad health insurance policies to ensure all your needs are covered.
Before you travel, understand the procedure to file an insurance claim while in another country. You may have to pay your bills in that country, sometimes in cash, and then submit copies of receipts to your insurance company for reimbursement.
STEP 6: Schedule Health Exams
Start them three months before you travel. Plan for a full health exam and needed immunizations. Make sure your health records are updated with all health care providers, and get a full copy of them before you go. Things to schedule for:
ANNUAL PHYSICAL EXAM—Have one if it's been more than a year. Get health records updated. If relevant to your medical condition, include EKGs and X-rays in your records. Also ask your physician for ways to prepare for and beat jet lag, or other travel-related physical discomforts.
PRESCRIPTION UPDATE—For every routine/daily medication, get a prescription for the full amount you will need the entire time you are abroad, and purchase them before you travel. If your insurance company won't allow this, check with your ed-abroad program to see if arrangements can be made to have prescriptions filled while you are abroad. Get prescriptions for generic versions of all medications too; pack those in your health records file that you take with you.
GYNECOLOGICAL EXAM—Have an annual GYN check-up well before your travel dates, and bring up personal concerns or prescription requirements.
VISION CHECK-UP—Get an eye exam and updated prescriptions for eyeglasses and/or contact lenses, and any medications.
DENTAL CHECK-UP—Have one and make sure any special procedures or medication needed for your dental treatment are noted in your dental records.
STEP 7: Pack a Health Records File and a Health Safety Kit
ESSENTIAL ITEMS IN YOUR HEALTH FILE:
- Immunization records, particularly those required for current travel
- Your blood type
- Eyeglass, contact lens, and medication prescriptions (with generic drug names)
- EKGs and X-rays (when relevant)
- Doctor's statement about any special health problems
- Dental records, particularly if special procedures or medications are indicated
- Education abroad contact information, both overseas and at your home school
- Family contact information
- Health and emergency names and numbers: e-mail, phone, address, and fax information from back home, i.e. your primary physician, dentist, and others who hold your records on file. Also note important numbers such as the U.S. consular office in your new location and the U.S. Department of State's Overseas Citizens Service Center (see U.S. Department of State information in the Travel Health Resources section at the end of this guide).
Leave a full copy of all these records at home with someone you can contact.
YOUR PERSONAL HEALTH KIT:
DRUGS, MEDICATIONS AND INSTRUMENTS—Take a full supply of the prescription, and over-the-counter, drugs that you use at home to cover the full time you will be abroad. Because you are overseas, don't stop taking prescription medications! If you self-administer any medications, take a supply of those as well, unless you confirm ahead they can be readily and safely purchased at your destination or learn that you can't take them into the country with you . Be aware that in some developing countries, health care providers reuse syringes.
BACKUP EYEGLASSES, CONTACT LENSES, DENTAL EQUIPMENT, ETC.—Take any needed, and back-up dentures or other dental equipment if needed.
BIRTH CONTROL, IF USED—Based on your lifestyle, plan for sexual health while abroad. Bring contraceptives or your own condoms. If available at all, condoms in some locations may be inferior and offer poor protection. See a physician immediately if you become pregnant while abroad.
OTHER FIRST AID AND OVER-THE-COUNTER HEALTH AIDS—Depending on the location, you may want bandages, adhesive tape, gauze, antibacterial ointment/antiseptic cream, sun block, sunburn ointment, aspirin or other over-the-counter painkiller, anti-diarrhea medicine, waterless hand cleanser, sanitary products as needed.
Depending on the region, you may need: water purification tablets, antihistamines for allergy relief, skin and lip moisturizers, and insect repellent.
Office of International Programs
Farrington Building, Suite 116, Huntsville, TX 77340