Chapter 8 Advising Travelers with Specific Needs
Study Abroad & Other International Student Travel
US student participation in study abroad has more than tripled in the past 2 decades. In the 2011–2012 academic year, 283,332 US students studied abroad for academic credit—an increase of 3.4% over the previous academic year. Although the top 4 destinations were European countries, 15 of the top 25 were outside Europe. The percentage of students choosing destinations in sub-Saharan Africa, Asia, or the Middle East has approximately doubled over the past decade. Substantial numbers of students are studying in countries where health concerns and endemic diseases differ from those in the United States and Western Europe. Along with students going abroad as a part of their US college or university degree program, a number of US students earn a full undergraduate or graduate degree outside the United States.
Study abroad and international travel can be life-changing and positive experiences. However, students and families must plan for and understand health and safety risks. Part of the plan should include obtaining, before departure, health care and advice from a medical specialist, an assessment of potential local health and safety risks, mitigation strategies, and knowledge of local resources to support a healthy and safe stay abroad. Further resources are included in Table 8-05.
ADMINISTRATION OF STUDY-ABROAD PROGRAMS
The largest number of study-abroad programs for US students are ≤1 year and are integrated as a part of the US degree program. Study-abroad programs vary by administrative structure. Some are administered overseas by a local university, with no US staff support onsite. Others are administered by US colleges and universities that obtain legal status in the country where the program is offered and bring faculty and staff from the United States to run or teach in the program. Others hire local staff or resident directors to administer their centers abroad or partner with nonprofit or for-profit companies that provide study-abroad programs (often referred to as third-party providers). Some US universities have developed branch campuses outside the United States where students can obtain a complete US degree. Hybrid versions combine 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 hire 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 meet with a travel health specialist before travel to selected countries, in addition to obtaining a predeparture health reviews 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 help students understand how 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 8-05. Study-abroad resources
NAFSA: Association of International Educators, www.nafsa.org
Responsible Study Abroad: Good Practices for Health & Safety, by the Interorganizational Task Force for Safety and Responsibility in Study Abroad http://www.nafsa.org/Find_Resources/Supporting_Study_Abroad/Network_Resources/Education_Abroad/Responsible_Study_Abroad__Good_Practices_for_Health___Safety/
Useful information for institutions implementing studyabroad programs, as well as information for students to support their health and 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), www.csiet.org/
Standards for exchange programs for US high-and middle-school students going abroad
Health and safety good practices
Center for Global Education, SAFETI (Safety Abroad First–Educational Travel Information) Clearinghouse, http://globaled.us/safeti
SAFETI Program Audit Checklist http://globaled.us/SAFETI/program_audit_checklist.asphttp://studentsabroad.com
Resources to support study-abroad program development and implementation, emphasizing health and safety issues and resources for US colleges and universities supporting study abroad
List of health and safety and study-abroad issues to guide institutions’ policies and procedures
Resource website for students that includes a country-specific handbook
University- and high school-level online courses that provide students with helpful information, including health and safety information before, during, and after study abroad
|Forum on Education Abroad www.forumea.org||Standards of good practice, a code of ethics, and resources for institutions and organizations that sponsor and support study-abroad programs|
Study-abroad program advisors should collaborate with institutional medical professionals to provide students with a comprehensive pre-travel consultation that includes an assessment of the student’s health and immunization history, length of program, activities, and other travel that the student will be engaging in during the academic term abroad, in addition to the following:
- Country- and region-specific health and environmental information
- Gender-specific health information
- Required, recommended, and routine vaccinations
- Recommended prophylactic and self-treatment medications and first aid kit (see Chapter 2, Travel Health Kits)
- Advice and resources for students with special needs and disabilities, including a specific plan for students with preexisting conditions that includes provisions for medications, ongoing care, and emergency treatment
- Information about physiologic and psychological consequences they may encounter as a result of culture shock or changes in their routine
- General advice on nutrition and dietary deficiencies
- Cautions about alcohol and drug use and a specific plan for those with preexisting dependency issues
- Rabies education (avoid feeding or petting animals, and postexposure measures)
- Bloodborne pathogens precautions (needles, blood products, tattoos, piercing, surgeries, acupuncture) and safe sex (including emergency contraception)
- General instructions for emergency medical situations, including locating a physician abroad (see Chapter 2, Obtaining Health Care Abroad for the Ill Traveler)
- Full health and accident insurance policies and emergency assistance coverage information, including medical and evacuation insurance
- Pre-travel medical and dental exams
Before departure, study-abroad advisors and health professionals should encourage students to continue learning about the countries they will visit, to understand the health and safety issues as well as the cultural and political climate.
The information in the Humanitarian Aid Workers section earlier in this chapter can be useful for students participating in study abroad, internships, field studies, community service projects, or research in the developing world.
The Department of State’s online re-source for students (http://studentsabroad.state.gov) includes comprehensive information to help students plan healthy and safe experiences abroad. Their travel website (http://travel.state.gov) provides country-specific information, including issues like crime and transportation safety. Students should check to see whether there is a travel warning or travel alert for the countries they will visit, and take this information into account when making travel decisions. They should have enough background information about the countries they will visit and know how to get help at a US embassy or consulate during an emergency. Before departure, students should be encouraged to register with the Department of State’s Smart Traveler Enrollment Program (STEP, available at https://step.state.gov/step/). College and university representatives can also register their students as a group with STEP.
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. In most developing countries, students should drink only beverages from factory-sealed bottles or water that has been purified (see Chapter 2, Water Disinfection for Travelers). Students should also be advised to avoid ice in drinks, as the ice may have been made with unsafe water.
Cooked foods should be eaten hot; raw fruits and vegetables should be eaten only if they can be washed in clean water or 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 & Water Precautions for more information. Travelers may also wish to download CDC’s Can I Eat This? app (wwwnc.cdc.gov/travel/page/apps-about) for on-the-go safe food and water guidance.
Adherence to Host Country Laws and Codes of Conduct
Study-abroad professionals and others working with student travelers should advise students that host country and host institution rules and regulations may differ from those on a home campus and in the United States. Students must abide by the legal system of their host country. Additional information on host country laws may be found on the Department of State website (http://travel.state.gov).
Mental and Physical Health
Students must consider their own mental and physical health when applying to a study-abroad program and discuss any existing medical or mental-health issues with their families and health professionals to minimize potential problems.
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.” US college and university campuses continue to see an increase in the numbers of students with mental health issues who go abroad. Dealing with stressful situations abroad may be difficult for students away from their familiar support system, which may trigger mental and physical issues. Students should be encouraged to disclose any chronic physical or mental health conditions or accommodation needs before departure. Advisors can encourage students’ disclosure by assuring confidentiality and explaining that the information is needed to facilitate a safe experience while abroad—not to prevent them from going.
Mobility International USA (www.miusa.org) provides information and resources to support study abroad by students with special needs and can be contacted directly for assistance.
Students must travel with a signed prescription for all medications that indicates the name of the student, the name of the medication (both brand name and generic, as well as the international name if different), the dosage and quantity prescribed, as well as a letter from the US treating physician explaining the recommended dosage, the student’s diagnosis, and the treatment. This is especially important for controlled substances and injectable medications. Translations of these documents to the host country language may be helpful. It is a good idea to leave copies of prescriptions with a family member or friend at home. In most countries, arriving with quantities exceeding those prescribed for personal use is prohibited.
Medications commonly prescribed in the United States may not be legal in the host country. Students should check with the US embassy or consulate before traveling regarding the legality of their prescription medications, discuss with their health care providers whether some medications should be changed, and allow sufficient time to make adjustments before study abroad. Students should avoid switching medications immediately before departure and should not discontinue prescribed medications while abroad unless instructed by a health care professional.
US prescriptions are not accepted by pharmacies overseas, and some prescription medications may not be available in host countries. 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). Shipping or mailing medications may not be a viable option because many countries’ laws prohibit the mailing of drugs, including prescription medicines.
Students should pack all medications in the original, labeled containers in their carry-on baggage.
Students should print and fill out an emergency information card (if one is not provided by the program, a sample can be found at http://studentsabroad.com/emergencycard.asp) with contact numbers and personal information, and carry a copy with them at all times. Students should share information on overseas contacts with their emergency contacts in the United States and 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 informed of their whereabouts and activities and provide them with copies of their travel documents (passport, visa, plane tickets, and prescriptions) and itinerary.
Transportation and Pedestrian Safety
Traffic crashes are a major cause of injury to students while traveling abroad. Students must 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, in collaboration with institutional experts, should conduct a proper orientation about the risks associated with drinking and abusing drugs abroad.
- Forum on Education Abroad. Code of ethics for education abroad. Carlisle, PA: Forum on Education Abroad; 2008 [cited 2012 Sep 24]. Available from: http://www.forumea.org/documents/ForumonEducationAbroadCodeofEthics.pdf.
- 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 2014 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, 2000/01–2011/12. New York: Institute of International Education; 2013 [cited 2014 Sep 24]. Available from: http://www.iie.org/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 2014 Sep 24]. Available from: http://www.nafsa.org/Find_Resources/Supporting_Study_Abroad/Network_Resources/Education_Abroad/Responsible_Study_Abroad__Good_Practices_for_Health___Safety/.
- NAFSA: Association of International Educators. Best practices in addressing mental health issues affecting education abroad participants. Washington, DC: NAFSA: Association of International Educators; 2006 [cited 2014 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.
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- Page last updated: July 10, 2015
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