Chapter 9 Travel for Work & Other Reasons
Study Abroad & Other International Student Travel
Students and their families are responsible for planning for and understanding health and safety risks. They are encouraged to contact study abroad program administrators before departure to discuss the local view and approach to health issues, legality of prescribed medications, and standards of health care in the country where they are going. Preparation can help reduce a student’s chances of becoming ill overseas and engaging in behaviors that can put them at increased risk.
Study abroad programs vary in structure and staffing, resources and level of support provided, and obligations placed on students. Some institutions have several employees (study abroad professionals) dedicated to supporting study abroad programs—this includes people who have expertise on international health and safety issues and who have the background to make specific recommendations regarding insurance coverage; other programs have limited or no staff dedicated to such activities.
The pretravel consultation with a health care provider should cover those items that any pretravel counseling session includes: risk assessment, risk mitigation, and preparation to respond effectively to health and safety issues while abroad (see Chapter 2, The Pretravel Consultation).
Travel health professionals can think about dividing risk mitigation practices for students traveling overseas into 2 categories: general and specific considerations. General risk mitigation activities—those that might apply to anyone traveling internationally—include:
- Ensuring appropriate immunizations for the destination: routine, recommended, and required vaccinations need to be reviewed and administered as necessary
- Providing recommended prophylactic and self-treatment medications and first aid kit (see Chapter 6, Travel Health Kits)
- Providing country- and region-specific environmental health and safety information
- Guidance for managing chronic health conditions, including compromised immunity
- Providing information about how to obtain routine and emergency medical and dental care while abroad
- Assisting travelers with finding out whether their medications can be brought into other countries legally
- Managing stress and other mental health issues associated with international travel, including culture shock, jet lag and altered sleep patterns
- Encouraging students to register with the Department of State’s Smart Traveler Enrollment Program (STEP, https://step.state.gov/step/)
Travel health professionals are also encouraged to take the time to discuss with student travelers these additional, specific topics:
- The importance of purchasing a travel insurance policy that covers major medical, evacuation, and repatriation: student insurance options offered through the parent institution may be a reasonable, cost-effective option for the student traveler
- Gender-related health issues, including information for lesbian, gay, bisexual, and transgender (LGBT) students
- Good oral hygiene and dental care
- Proper nutrition and diet
- Alcohol and (illicit) drug use: this may include making arrangements for those with preexisting dependency issues
- Bloodborne pathogen precautions: avoiding needles, blood products, tattoos, piercing, surgeries, acupuncture
- Practicing safe sex, including what to do in the event of pregnancy
- Water and extreme sport risks
Providing support for students with special needs, disabilities, or preexisting health conditions may require travel health professionals to collaborate with study abroad professionals.
Study abroad professionals should share general instructions with students about how to locate physicians and mental health providers for emergency and non-emergency situations. They should also encourage students to familiarize themselves with the study-abroad codes of conduct for their home and host institutions, as well as local health and safety issues, cultural norms, laws, and political climate.
Students who self-identify as LGBT should familiarize themselves with local laws, cultural attitudes, and tolerance in their proposed host country. Identifying health care providers in the host country with experience working with LGBT people (if desired) may require additional research and planning; students should prepare accordingly. The Department of State website (http://travel.state.gov) and specific US Embassy or Consulate websites in the countries and cities around the world where they are located (www.usembassy.gov) are useful sources of information on host country laws.
International travel can be stressful for anyone, particularly students away from their usual support systems. Culture shock, isolation, loneliness, fear, and insecurity can exacerbate existing mental health issues or unveil new ones (see Chapter 3, Mental Health). Students should consider their preexisting mental and physical well-being, and the availability of local resources, when deciding on a destination for study. Encourage students to take an active role in planning for transition support, as well as care abroad, by disclosing all chronic mental health conditions and support needs before departure.
Alcohol and Illicit Drugs
Use and abuse of alcohol and illicit drugs pose serious health consequences, can increase the risk of accidents and injuries, and make students potential targets for crime and incarceration. Moreover, availability and/or use of drugs by citizens of host countries may not translate to legal use by international travelers.
Although marijuana may be legal under certain US state laws, its use continues to be illegal under US federal law. US airports and airlines operate under federal jurisdiction and, as such, do not recognize the medical marijuana laws or cards of any state. Even with a US prescription for marijuana use, students found in possession of marijuana in countries outside the US where it is illegal can be arrested, fined, prosecuted, or imprisoned and deported.
Some drugs legally prescribed for use in the US may be illegal abroad. Travel health providers and personal physicians should review whether prescribed drugs are legal at the destination. In some instances, where a drug prescribed for use in the US is not legal at the student’s intended destination, a weaning period or changing prescriptions (with enough lead time before travel to identify any adverse effects) may be appropriate medical practice.
All prescriptions carried internationally must indicate the student’s name, the name of the medication (brand name and generic), and the dosage and quantity prescribed. Treating physicians should provide a letter explaining the student’s diagnosis and the recommended treatment. Translations of documents into local languages may be helpful and in some cases, required. Instruct students to pack a copy of the physician’s letter along with all medications (in their original, labeled containers) in their carry-on baggage. Some destinations may require disclosure of prescription medications when clearing customs.
Most countries prohibit arriving travelers to import quantities of medication greater than what has been prescribed for personal use. For study abroad exceeding 90 days, students should—where possible—fill prescriptions in the US that will cover them for the full duration of their time away from home. Some medications may be unavailable for sale at the destination; if available, counterfeit or poor-quality medication purchased overseas poses another potential health risk (see Chapter 6, Perspectives: Avoiding Poorly Regulated Medicines and Medical Products during Travel).
Because pharmacies in other countries do not accept prescriptions written by US providers, students who anticipate needing to refill a prescription while abroad must be prepared to schedule an appointment to visit a local doctor to obtain a valid, accepted prescription. Students need to determine before travel whether their travel insurance policy covers such appointments; insurers may consider this to be preventive care and refuse coverage.
Travel health professionals should discuss safe sex practices (condom use, birth control, and emergency contraception) and provide information about the prevalence of sexually transmitted infections and diseases at the destination. Encourage students to learn about the social customs of their host city and country with regard to dating and public displays of affection.
Water and Extreme Sports
Drowning is a leading cause of death, both at home and away. Students should know how to swim or avoid swimming while abroad. Warn students about the risks associated with swimming in unfamiliar bodies of water without a lifeguard present. Before venturing into the water, students should ask lifeguards about any known dangers. Advise students not to go into the water while intoxicated and to always have a swimming buddy. Discuss unforeseen risks in both fresh water (schistosomiasis) and salt water (marine envenomations). Students planning participation in extreme sports (e.g., skydiving, rafting, scuba diving) should be cautioned to reconsider; at the very least, they should be knowledgeable about the risks and encouraged to obtain extreme sport coverage as part of their international travel health insurance policy.
Emergency Contact Information Card
Students should carry their personal information and important telephone numbers at all times, both in hard copy and entered into their mobile device. A sample emergency contact card can be found at http://studentsabroad.com/handbook/emergency-card.php?country=General. Travel health professionals can assist students with special physical or mental health needs by describing in writing all health issues and recommended care; in preparing to go abroad, students should ensure that this letter gets translated accurately into the local language(s).
DURING AND AFTER TRAVEL CONSIDERATIONS
During their time abroad, students should seek health care immediately if they become ill, injured, or have a bloodborne pathogen exposure. Students should adhere to food and water precautions (see Chapter 2, Food & Water Precautions) and use insect repellent (see Chapter 3, Mosquitoes, Ticks & Other Arthropods) to prevent vectorborne diseases.
Students who become ill after study abroad should alert health care providers about their international travel. Fever within 1 year of return from a study abroad program in students who traveled to malaria-endemic countries mandates immediate testing for the disease (see Chapter 4, Malaria). Students with new sexual partners while abroad should be tested for sexually transmitted infections and diseases, including gonorrhea, chlamydia, and HIV, if they become symptomatic while abroad, but certainly following return home.
The US Department of State has online resources to assist both students and study abroad programs with considerations and advice for study abroad travel (https://travel.state.gov/content/travel/en/international-travel/before-you-go/travelers-with-special-considerations/students.html). Additional resources for study abroad are provided in Table 9-02.
Table 9-02. Online health and safety information resources for study abroad students
|ORGANIZATION||HEALTH & SAFETY INFORMATION PROVIDED|
|US Department of State
Bureau of Consular Affairs
|Centers for Disease Control and Prevention
|Center for Global Education Safety Abroad First– Educational Travel Information (SAFETI)
NAFSA: Association of International Educators
|Forum on Education Abroad
|International Narcotics Control Board
US Department of State—Overseas Security Advisory Council
|Pathways to Safety International, formerly Sexual Assault Support & Help for Americans Abroad
- Angelin M, Evengård B, Palmgren H. Illness and risk behavior in health care students studying abroad. Med Educ. 2015;49(7):684–91.
- Aresi G, Moore S, Marta E. Drinking, drug use, and related consequences among university students completing study abroad experiences: a systematic review. Subst Use Misuse. 2016;51(14):1888–1904.
- Institute of International Education. U.S. students study abroad 2015/2016 data; 2017. [cited 2018 Jan 10]. Available from: www.iie.org/Research-and-Insights/Open-Doors/Data/US-Study-Abroad.
- 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 2018 Jan 17]. Available from: www.nafsa.org/mentalhealth.