Chapter 8Advising Travelers With Specific Needs
Study Abroad & Other International Student Travel
Study abroad allows students to complete part of their US degree program outside the United States. International experiences can include classroom study, research, internships, service learning, environmental field studies, and directed travel. Generally, study abroad refers to programs where students earn academic credit for their academic work abroad. However, many students travel abroad for nonacademic programs, which can include athletics, adventure activities, noncredit internships, volunteer or mission groups, and personal international travel.
US student participation in study abroad has more than tripled over the past 2 decades. In the 2009–2010 academic year, 270,604 US students studied abroad for academic credit—an increase of 3.9% over the previous academic year. Although most study in European countries, US students are now spending time in countries all over the world. Fifteen of the top 25 destinations are outside Western Europe. The percentage of students choosing to travel to Africa, Asia, and the Middle East has risen, while the percentage choosing to study in Europe and Oceania has decreased. Substantial numbers of students are now studying in developing countries, where health concerns and endemic infections differ from those in the United States and Western Europe.
Study abroad and international travel can be life-changing and positive experiences for college and university students. However, students and families must take time and effort to plan for study abroad and other international travel to be proactive in supporting health and safety and prepared to respond to incidents abroad. Further resources are included in Table 8-09.
ADMINISTRATION OF STUDY-ABROAD PROGRAMS
Study-abroad program types and administrative structures vary. Some are administered overseas by a local university, with no US staff support onsite. Other US colleges and universities obtain legal status in the country where the program is offered and bring faculty and staff from the United States to run the program. Others hire local staff or resident directors to administer their centers abroad, or partner with nonuniversity, nonprofit or for-profit companies that provide study-abroad programs (often referred to as third-party providers). There are also hybrid versions combining formal connections to international universities with parts of programs administered by the US campus or a third-party provider.
Institutional administrative structures in the United States can vary as well. Some institutions have several study-abroad staff, while others have no full-time staff members. Some universities have specialized professionals to focus on health and safety issues, while others have no staff dedicated to health and safety support. Some institutions require health insurance that integrates comprehensive medical care, 24-hour assistance, emergency evacuation, and repatriation. Other institutions may recommend obtaining comprehensive health insurance for study abroad but may provide limited or no information about available options.
Some colleges and universities recommend or require that students visit a travel health clinic before travel to specific countries, in addition to obtaining a predeparture health clearance for all countries. Whether or not a university offers pre-travel health clinic support, students should consult with a medical professional as a part of the planning process before study abroad. This consultation should be designed to help students understand what they must do to prepare for a safe and healthy stay in their host country. It should include information on endemic health issues in the host country, availability of medications commonly prescribed in the United States, and information on how to obtain medical care abroad.
Table 8-09. Study-abroad resources
NAFSA: Association of International Educators, www.nafsa.org
Useful information for institutions implementing studyabroad programs, as well as information for students to support their health and safety
“Responsible Study Abroad: Good Practices for Health & Safety”: Advice for developing plans and procedures to implement good practices for program sponsors, students, and parents/guardians/families, especially those pertaining to health and safety issues
Council on Standards for International Educational Travel (CSIET), http://csiet.org/about/standards.html
Standards for exchange programs for US high school students going abroad
Health and safety guidelines
Center for Global Education, SAFETI (Safety Abroad First–Educational Travel Information) Clearinghouse, http://globaled.us/safeti
Resources to support study-abroad program development and implementation, emphasizing health and safety issues and resources for US colleges and universities supporting study abroad
SAFETI Program Audit Checklist
Resource website for students that includes a country-specific handbook
|Forum on Education Abroad www.forumea.org/standards.cfm||Standards of good practice and a code of ethics for the field of education abroad|
Study-abroad program advisors should work with medical professionals to provide the students with a comprehensive pre-travel consultation, including any routine, recommended, and required vaccinations, recommended prophylactic and self-treatment medications, and pre-travel counseling and advice. The pre-travel consultation should also include the following:
- Country- and region-specific health information
- Gender-specific health information
- Advice and resources for students with disabilities
- Information about physiologic and psychological consequences they may encounter as a result of culture shock and changes in their routine, and a specific plan for students with preexisting conditions
- General advice on nutrition and dietary deficiencies
- Cautions about alcohol and drug use and a specific plan for those with preexisting dependency issues
- General instructions for emergency medical situations
- Full health and accident insurance policies and emergency assistance coverage 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 their destinations to understand the health and safety issues of the countries they will visit. This also includes reading about the cultural and political climate of those countries.
The Department of State hosts a website specifically for students (http://studentsa broad.state.gov) with direct links to information on passports, visas, crime, safety, security, transportation challenges, and resources for US citizens during international travel. The Department of State provides country-specific information on their website (http://travel.state.gov/travel/travel_1744.html). Students should check on whether there is a travel warning or travel alert providing specific concerns about safe travel to countries they will visit. Travel warnings are issued when long-term, protracted conditions that make a country dangerous or unstable lead the Department of State to recommend that Americans avoid or consider the risk of travel to that country or when the US government’s ability to assist American citizens is constrained. Travel alerts are posted to disseminate information about short-term conditions that pose risks to the security of US citizens. Alerts may be posted for security risks, political or civil unrest, armed conflicts, natural disasters, and terrorist attacks. Before departure, students should consider registering with the Department of State’s Smart Traveler Enrollment Program (STEP, available at step.state.gov) to receive updates and information about their host country from the US embassy or consulate and make the process smoother if they need help while abroad or if someone from the United States is trying to contact them.
The CDC Travelers’ Health website (www.cdc.gov/travel) contains advice for travelers on the most current health recommendations for international destinations.
HEALTH AND SAFETY WHILE ABROAD
Food and Water Safety
Food and water contamination is one of the leading causes of illness for travelers. Basic precautions can minimize the risk of diarrhea and other illnesses. Specific food and water recommendations depend on the destination country. Consulting with a travel health professional is recommended. Some tips to help students regarding food and water safety include:
- Find out if tap water is safe to drink for non-locals. If it is unsafe—
- Purify unsafe water before drinking or drink only bottled water, making sure that the seals have not been tampered with. Use only purified or bottled water for brushing teeth. For more information, see Chapter 2, Water Disinfection for Travelers.
- Avoid ice in drinks, as it may also be unsafe depending on the water used to make it.
- Cooked foods should be eaten hot; raw fruits and vegetables should be eaten only if washed in clean water and then peeled by the traveler.
- 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
Study-abroad professionals and others working with student travelers should advise students about rules and regulations that may differ from those on a home campus, as well as those 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. Additional information on host country laws may be found in the Department of State Consular Information Sheets (www.travel.state.gov/travel/cis_pa_tw/cis/cis_4965.html).
Mental and Physical Health
The NAFSA: Association of International Educators’ publication, “Best Practices in Addressing Mental Health Issues Affecting Education Abroad Participants,” available at www.nafsa.org/mentalhealth, 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 to a study-abroad program.
US college and university campuses are seeing an increase in the numbers of students with special mental health issues. These issues go abroad with students. Students should be encouraged to disclose any chronic physical and mental health conditions or accommodation needs before departure to the country where they will study. Dealing with stressful situations abroad may be difficult for students away from their familiar support system, which may trigger mental and physical issues. Advisors can encourage students to disclose this information by assuring them that it is meant to maximize their experience while abroad—not to prevent them from going.
Students should discuss any existing medical or health issues with their families and health professionals before going abroad. Planning ahead can help them address challenges they may face. Students should not make changes to their medications immediately preceding their time abroad, nor should they discontinue taking prescribed medications while abroad, unless instructed to do so by a health care professional.
Students must travel with a signed prescription for all medications needed while abroad and a letter from the US treating physician explaining the recommended dosage, the student’s diagnosis, and the treatment. In most countries, arriving with quantities exceeding the limits set for personal use is prohibited.
Generally, US prescriptions are not accepted by host country pharmacies and cannot be filled without visiting a local medical practitioner first. Students must check first whether the US prescription will be readily accepted by a local pharmacy abroad. Students are highly recommended to fill prescriptions in the United States before departure, reducing the need to purchase medication overseas and decreasing potential exposure to counterfeit and poor quality medications (see Chapter 2, Perspectives: Pharmaceutical Quality & Counterfeit Drugs).
Medications commonly prescribed in the United States may not be available or legal in the host country. It is vital for students to research the availability and legality of their prescription medications before traveling, discuss with their health care providers whether some medications should be changed, and allow sufficient time to make adjustments before study abroad.
Shipping or mailing medications may not be a viable option because many countries’ laws prohibit the mailing of drugs, including prescription medicines, to individuals.
Students should print and fill out an emergency information card (http://studentsabroad.com/emergencycard.asp) with important contact numbers and personal information and carry a copy with them at all times. Students should share a copy of all important contact information while abroad with their emergency contacts in the United States, as well as share information for emergency contacts in the United States with the study-abroad program and the host school.
Students should keep both their program staff and their emergency contacts at home well informed of their whereabouts and activities and provide them with copies of their travel documents (passport, visa, plane tickets, and prescriptions) and itinerary.
Traffic crashes are a major cause of injury to students while traveling abroad. It is imperative for students to understand what safe and legitimate modes of travel are available in their host country. A good source of information is the Association for Safe International Road Travel at www.asirt.org.
Alcohol and Drugs
The misuse and abuse of alcohol and drugs abroad can increase the risk of accidents, injury, unwanted attention, and theft. Being in a foreign environment requires the ability to respond to new and changing circumstances, which is impaired under the influence of drugs or alcohol. Many students are not of legal drinking age in the United States but are in the host country. Many do not receive adequate alcohol- and drug-prevention education explaining the consequences of risky drinking and drug abuse before departure. Violating drug laws abroad may result in serious consequences. In some countries, being found guilty of violating drug laws can lead to life in prison or the death penalty. Study-abroad professionals should conduct a proper orientation about the risks associated with drinking and abusing drugs abroad.
- 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.
- Institute of International Education. Americans study abroad in increasing numbers. New York: Institute of International Education; 2009 [cited 2012 Sep 24]. Available from: http://www.iie.org/en/Who-We-Are/News-and-Events/Press-Center/Press-Releases/2009/2009-11-16-Americans-Study-Abroad-Increasing.
- Institute of International Education. Host regions of US study abroad students, 1999/00–2008/09. Open Doors report on international educational exchange. New York: Institute of International Education; 2011 [cited 2012 Sep 24]. Available from: http://www.iie.org/en/Research-and-Publications/Open-Doors/Data/US-Study-Abroad/Host-Regions.
- 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; 2002 [cited 2012 Sep 24]. Available from: http://www.nafsa.org/uploadedfiles/responsible_study_abroad.pdf.
- NAFSA: Association of International Educators. Best practices in addressing mental health issues affecting education abroad participants. New York: NAFSA: Association of International Educators; 2006 [cited 2012 Sep 24]. Available from: http://www.nafsa.org/mentalhealth.
- 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.
- The Forum on Education Abroad. Code of ethics for education abroad. Carlisle, PA: Dickinson College; 2008 [cited 2012 Sep 24]. Available from: http://www.forumea.org/documents/ForumonEducationAbroadCodeofEthics.pdf.