Chapter 8Advising Travelers with Specific Needs
Study-abroad programs are designed to allow students to travel outside the United States to obtain academic credit or to take part in community service projects, research, or internships sponsored through their college or university. Students may also travel to participate in athletics, adventure, and volunteer or mission groups.
The number of US study-abroad students has increased significantly in the past 10 years. In 1997, fewer than 100,000 students studied abroad; however, in 2008, more than 250,000 students received academic credit through study-abroad programs. Students study in countries all over the world. In 1998–99, approximately 62% of study-abroad students traveled to Europe. By 2007–08, this number had dropped to 56%. Substantial numbers of students now study in developing countries, where health concerns and challenges compared with those in the United States differ more widely than those in Europe. Table 8-12 shows the host regions of US study-abroad students from 1999–2000 through 2008–2009.
Table 8-12. US study-abroad students, percentage by host region1
2Cyprus and Turkey were previously classified in the Middle East category but were moved to the Europe category in 2004–05.
ELEMENTS OF STUDY-ABROAD PROGRAMS
Study-abroad programs are implemented in various ways. Some programs are administered overseas by an international university, with no US staff support onsite. Other US colleges and universities obtain legal status where the program is offered and bring faculty and staff from the United States to run the program.
Institutional administrative structures vary as well. Some universities have more than 20 study-abroad staff with an administrator to focus on health and safety issues. Some large colleges and universities have a travel health clinic for students to visit. Other institutions have no full-time study-abroad office or staff or support from a health clinic. Some study-abroad programs require health insurance that integrates comprehensive medical care, 24-hour assistance, emergency evacuation, and repatriation. Other institutions may recommend that students obtain health insurance for study abroad but may provide limited or no information about available options.
The pre-travel consultation for students planning to study abroad should provide background on health issues in the host country, including country health information and information on how to obtain medical care.
Study-abroad program advisors should work with medical professionals to provide the following to students:
- Cautions about alcohol and drug abuse
- Information about physiologic and psychological consequences they may encounter as a result of changes in their routine
- General instructions for emergency medical situations
- General advice on nutrition and dietary deficiencies
- Advice for students with disabilities
- Gender-specific health information
- Full health and accident insurance policy coverage information and identification
- Region-specific health information
The information in the Humanitarian Aid Workers section earlier in this chapter can be useful for students participating in study abroad, internships, or research in the developing world.
Before departure, advisors and professionals should encourage students to learn about the destination. Students should understand the health and safety issues of the countries they will visit. This includes reading about the cultural and political climate of those countries. The Department of State’s travel website (http://travel.state.gov/travel) provides information about travel abroad, primarily focusing on topics of passports, visas, safety, security, and resources for US citizens during international travel. For some countries, the department posts travel alerts or travel warnings to describe situations such as security risks, political or civil unrest, armed conflicts, natural disasters, and terrorist attacks. Travel warnings are issued when the Department of State recommends against travel to a certain country. The Department of State also hosts a website specifically for students (http://studentsabroad.state.gov/). The CDC Travelers’ Health website (www.cdc.gov/travel) contains advice for travelers on the most current health recommendations for international destinations.
Students may need to get vaccines to protect themselves from infectious diseases endemic in the areas they will visit. All travelers should visit a travel health provider, ideally 4–6 weeks before departure, to allow enough time to get recommended vaccines and prescriptions. Even if travel is imminent, students should still visit their travel health provider before departure. The quality of dental and medical care may be different in host countries or more expensive than similar care would be in the United States. Students should receive thorough medical and dental examinations, especially those who are going abroad for several months. Students should be encouraged to bring a well-stocked travel health kit as a first line of defense (see Chapter 2, Travel Health Kits).
HEALTH AND SAFETY WHILE ABROAD
Food and Water Safety
Being mindful with food and water selection can minimize the risk of diarrhea and other illnesses. Specific food and water recommendations depend on the destination country; however, some useful tips to help students regarding food and water safety are the following:
- Find out if water is safe to drink.
- Purify unsafe water before drinking or drink only bottled water, making sure that the bottles are sealed when purchased. Use only purified or bottled water for brushing teeth. For more information, see Chapter 2, Water Disinfection for Travelers.
- Avoid ice in drinks, since it can also be unsafe, depending on the water used to make it.
- Poor refrigeration, undercooked meat, and food purchased from street vendors could pose problems related to food contamination.
- See Chapter 2, Food and Water Precautions for more information.
Adherence to Host Country Laws and Codes of Conduct
Administrators should make students aware of the rules and regulations of the study-abroad program sponsor and the local laws and customs of the countries visited. Students must abide by the legal system of their host country.
Mental and Physical Health
The Association of International Educators’ publication “Best Practices in Addressing Mental Health Issues Affecting Education Abroad Participants” encourages study-abroad programs “to sensitively offer support that connects the student to professional help before a problem reaches a crisis state or seriously derails the student’s academic and career plans.” Likewise, students must consider their own mental and physical health issues when applying for a study-abroad program. Program administrators need to be made aware of all necessary health information to assist students with any special needs or advise on common risks. Dealing with stressful situations abroad may be difficult for students away from their known support system, which may lead to mental and physical issues.
A signed prescription for all medications needed while abroad should be obtained. Some prescriptions may need to be translated if they are to be filled abroad. It is preferable to have all prescriptions filled before departure, reducing the need to purchase medication overseas and decreasing potential exposure to counterfeit medications (see Chapter 2, Perspectives: Counterfeit Drugs).
Students can print and fill out an emergency card that includes important contact numbers and personal information. Students should leave copies of it with their US-based emergency contacts and emergency contacts abroad; students should also keep a copy with them at all times (http://studentsabroad.com/emergencycard.asp). Additionally, students should keep program staff and an emergency contact at home well informed of their whereabouts and activities and provide them with copies of their important travel documents (passport, visa, plane tickets, traveler’s checks, and prescriptions).
Accidents involving in-country travel are a major cause of injury to students abroad. It is imperative for students to understand what safe modes of travel are available at their destination.
Alcohol and Drugs
The use and abuse of alcohol and drugs abroad can increase the risk of accident and injury. Many students are not given adequate alcohol and drug health and safety training before going abroad, but this is a population that may be at risk for heavy drinking. Violating drug laws abroad may result in serious consequences. In some countries, being found guilty of violating drug laws can result in consequences as serious as death. Therefore, study-abroad administrators should conduct a proper orientation with medical and other professionals about the risks associated with drinking and abusing drugs abroad.
The Association of International Educators has published a set of good practices titled “Responsible Study Abroad: Good Practices for Health and Safety” for study-abroad sponsors to work with their overseas partners to develop plans and procedures for implementing good practices for students, especially with health and safety issues (www.nafsa.org/uploadedFiles/responsible_study_abroad_2.pdf?n=4131). As study abroad becomes more common among K–12 students, the Council on Standards for International Educational Travel has developed standards for exchange programs for US high school students going abroad (http://csiet.org/about/standards.html).
The Center for Global Education has developed the SAFETI (Safety Abroad First–Educational Travel Information) Clearinghouse to disseminate resources to support study-abroad program development and implementation, emphasizing health and safety issues and resources for US colleges and universities supporting study abroad (http://globaled.us/safeti). Part of this resource includes the SAFETI Program Audit Checklist (http://globaled.us/SAFETI/program_audit_checklist.asp).
- CDC. Travelers’ Health. Atlanta: CDC; 2010 [cited 2010 Oct 29]. Available from: http://wwwnc.cdc.gov/travel.
- Center for Global Education. Emergency card. Los Angeles: Center for Global Education. Available from: http://studentsabroad.com/emergencycard.asp.
- Center for Global Education. SAFETI adaptation of Peace Corps resources. Los Angeles: Center for Global Education; 2009 [cited 2010 Oct 29]. Available from: http://globaled.us/peacecorps.
- Center for Global Education. SAFETI clearinghouse. Los Angeles: Center for Global Education; 2005 [cited 2010 Oct 29]. Available from: http://globaled.us/safeti/.
- Center for Global Education. SAFETI on-line newsletter. Los Angeles: Center for Global Education; 2005 [cited 2010 Oct 29]. Available from: http://globaled.us/safeti/online_newsletter.asp.
- Center for Global Education. SAFETI program audit checklist. Los Angeles: Center for Global Education; 2005 [cited 2010 Oct 29]. Available from: http://globaled.us/safeti/program_audit_checklist.asp.
- Center for Global Education. Study Abroad Student Handbook. Center for Global Education; 2010. Available from: http://studentsabroad.com/.
- Council on Standards for International Educational Travel. CSIET standards. Alexandria [cited 2010 Oct 29]. Available from: http://csiet.org/about/standards.html.
- Gore J, Green J. Issues and advising responsibilities. NAFSA’s Guide to Education Abroad for Advisors and Administrators. 3rd ed. Washington, DC: NAFSA Association of International Educators; 2005. p. 261.
- Interorganizational Task Force on Safety and Responsibility in Study Abroad. Responsible study abroad: good practices for health and safety. Washington, DC: NAFSA: Association of International Educators; 2001 [cited 2010 Oct 29]. Available from: http://www.nafsa.org/knowledge_community_network.sec/educatio....
- Lindeman B. Best Practices in Addressing Mental Health Issues Affecting Education Abroad Participants 2008. Available from: http://www.nafsa.org/knowledge_community_network.sec/educa....
- Open Doors. Americans study abroad in increasing numbers. New York: Institute of International Education; 2009 [cited 2010 Oct 29]. Available from: http://www.iie.org/en/Who-We-Are/News-and-Events/Press-....
- Open Doors. US study abroad: host regions 1999/00–2009/10. New York: Institute of International Education; 2010 [cited 2010 Nov 30]. Available from: http://www.iie.org/en/Research-and-Publications/Open-Doors/D...
- Pedersen ER, LaBrie JW, Hummer JF. Perceived behavioral alcohol norms predict drinking for college students while studying abroad. J Stud Alcohol Drugs. 2009;70(6):924–8.
- Sobel R. The association for safe international road travel. Los Angeles: Center for Global Education; 1999. Available from: http://globaled.us/SAFETI/online_newsletter.asp.
- The Forum on Education Abroad. Code of ethics for education abroad. Carlisle, PA: Dickinson College; 2008. Available from: http://www.forumea.org/documents/ForumonEducationAbroadCodeofEthics.pdf.
- US Department of State. Country specific information. Washington, DC: US Department of State; 2010 [cited 2010 Oct 29]. Available from: http://travel.state.gov/travel/cis_pa_tw/cis/cis_4965.html.
- US Department of State. International travel. Washington, DC: US Department of State; 2010 [cited 2010 Oct 29]. Available from: http://travel.state.gov/travel/travel_1744.html.