# International Service Learning Study Abroad Handbook/Health
## Introduction

Maintaining your health can become a greater challenge when traveling abroad. The differences between your own country and your country of travel can be profound and everything from the weather to infectious diseases can dramatically affect your health. It is crucial to increase your awareness about international health issues if you plan to visit foreign destinations. Learn all you can about the health and safety issues of the countries you plan to travel too. This includes researching the health care system, common diseases, and cultural differences of foreign destinations. It is in your best interest to become aware and learn about how local members of the foreign country view citizens of your home country, race, ethnic group, religion, gender and sexual orientation. It is not only necessary to have a full understanding of common sicknesses and diseases in the region that you are traveling to, but to also know what kinds of immunizations and documentation you will need in order to travel to your destination. If you have any medical or mental conditions that could possibly require treatment while abroad, discuss this ahead of time with your doctor to come up with a plan to maintain your condition while overseas.
Remember, if you travel to a destination where the elevation is much higher than here in the Northwest, it may take you body time to adjust to the altitude. You may find yourself short of breath or feel tired more often because the air is thinner at greater elevations. Once your body adapts to the changing elevation, you become acclimatized, which means you are able to function in the new environment with less oxygen. Acclimatization can take 1-3 days.
It is especially important to know that health care globally is wide-ranging, so keep in mind that depending on the region and the seriousness of your health condition, you may or may not want to receive medical care. Information about specific health issues in foreign countries is available via the internet and more specifically through the ‘WHO’ website which provides specific health information for all the regions of the world.

## Health Insurance Abroad

When traveling abroad, it is important to consider how you will receive health coverage. According to the website for Butler University, quite a few countries demand that travelers provide proof of medical insurance before they can admitted to a hospital. Upfront payments of cash are not uncommon. Anytime you visit a healthcare facility save all bills and receipts. Check with your current health insurance to see if they will cover you while abroad. Some policies provide an air ambulance in the event that you must sent home. Without insurance, such a trip would cost around $10,000. You may want to seek supplemental insurance that provides better coverage while you are abroad. As with many other aspects of traveling, the best way to prepare and ensure you have the best experience possible is to do research and learn as much as you can about your insurance options. Specific plans exist for students who are traveling abroad. Butler University lists some agencies on the page linked below. They also include questions to ask your insurance about travel plans such as: what type of coverage does the international health insurance provide? How much does the policy cost? Are there any eligibility requirements for the policy? Is the coverage valid in the specific country to which I am traveling? An article in USA Today also specified the difference between temporary insurance and travel insurance. The latter may provide assistance with small mishaps or emergency situations, but it is designed to cover lost luggage. Some health insurance policies don't cover travelers abroad, while others require the traveler to pay for all health costs incurred in other countries, then reimburse the insured upon their return to the U.S. Some plans are designed specifically for students who are studying abroad. The plans are often arranged through colleges and universities. The coverage can also be attained through parents' healthcare.The plans tend to more flexible to fit the variety of time period's students travel abroad.

## Personal Well-being

When traveling overseas it is important to consider your own mental and physical health. While the introduction to new and foreign cultures greatly benefits an individual, it can also be overwhelming. People experience distress when their stress level goes beyond their comfort zone, which can easily happen with language barriers and in an unfamiliar environment. Emotional discomfort can have a negative impact on an individual’s personal relationships, academic progress, and enjoyment of their experiences abroad.
Homesickness is one of the most common adjustment problems among culture shock and depression while overseas. Feelings of homesickness sometimes begin before you leave abroad and you may find yourself feeling lonely or anxious several weeks before leaving. The anticipation and eagerness for this major change of lifestyle can initiate pre-departure homesickness, feelings that you don’t want to leave, or even thoughts of changing your mind. If you experience homesickness while abroad, confront your feelings and talk to someone about your homesickness. It is also important to make friends with the locals because they can be a great support system while you are in their country. Getting involved in projects and opportunities within the community is a great way to keep busy so you don’t think about home.
Culture shock is another common condition that many people experience when they are first exposed to a different culture. Some common symptoms of culture shock include: irritability, overeating or loss of appetite, withdraw from people, and in some cases depression. Adjusting to a new culture takes time and proceeds in different ways for different people. Some common recommendations offered to travelers are to participate in community activities, building lasting relationships with community members, exercise, work on overcoming language barriers, and to be patient.
Sometimes going abroad may in fact magnify an existing condition– for instance, diabetes, high blood pressure, or other medical conditions that need to be monitored. It is recommended that before traveling to a foreign country, you create a workable plan for managing your mental health and personal well-being while abroad. The availability and quality of physical and mental health services differ widely from country to country. Health care systems in host countries may be different than what you are use too in their level of verification and responsiveness of physical and mental health needs. Be prepared to advocate for yourself in the event that you need health care. Be alert of your mental health, stress level, and personal well-being during your stay and keep information handy about existing resources available in your host country for assistance.
It's really important to take care of yourself and rest when you get sick. I got sick several times in Kenya and I had to stay in and rest even though I felt like I was missing out. I had to miss going out the first time because I was sick but it's important to do so. One of the other students also got sick several times and spent time in the sick room. It is also important to take care of each other. When people can't get up for meals we would grab some food and bring it to the sick person.
Homesickness also strikes everyone at different times. It's equally important to take time for your mental health. When we got homesick it really helped to talk to each other. We told each other about our families and what we missed about home. It's a great way to get to know each other and help each other emotionally.

## Vaccinations

It is a good idea to get an appointment set up with your doctor or a travel medicine provider up to 4 to 6 weeks before your trip. It is important to get these appointments done early because it takes time for most vaccines to become effective in your body. Also, some vaccines must be given in a series over a period of time which could take up to weeks to complete. If your trip is in less than 4 weeks, it is still a good idea to see your doctor. Better late than never, you may still benefit from vaccines that do not take a long time to administer and information about how to protect yourself from infectious illness or injury while you are traveling. The Center for Disease Control splits up the vaccinations into three types: routine, recommended, and required. Your doctor will help you make a decision on while vaccinations to get for your trip, but you should be aware that not all of them are required. It is a wise for you and your family to keep up to date on routine vaccinations. Routine vaccinations protect against diseases that are common in many parts of the world although they may appear to be rare because we live in the United States. If you are unsure about which vaccinations are routine, more information can be found by following the links from CDC below.
Recommended Adult Immunization Schedule
Recommended Childhood and Adolscent Immunization Schedule
Vaccine Recommendations for Infants and Children
Recommended vaccinations are to protect travelers that are present in their country of travel but not in other countries. They are recommended as an effort to prevent the importation of infectious illness across international borders. These vaccinations vary depending on your destination. Below you can find a list of countries to find specific information for your travel plans.
Currently the only required vaccination is yellow fever vaccination for travel to certain countries in sub-Saharan Africa and tropical South America. This vaccine is required by International Health Regulations.

## Vaccination Information by Destination

It is important to be aware of specific vaccinations that you or others you are traveling with may need to get before your departure. Below are some countries that are visited on study abroad programs. In these links you can find specific health information for travelers to specific countries including current travel notices, safety and security, recommended vaccinations, and more. Click the link below that matches the country you are going on your travel.
Algeria http://wwwnc.cdc.gov/travel/destinations/algeria.htm
Argentina http://wwwnc.cdc.gov/travel/destinations/argentina.htm
Australia http://wwwnc.cdc.gov/travel/destinations/australia.htm
Belgium http://wwwnc.cdc.gov/travel/destinations/belgium.htm
Brazil http://wwwnc.cdc.gov/travel/destinations/brazil.htm
Cambodia http://wwwnc.cdc.gov/travel/destinations/cambodia.htm
Cameroon http://wwwnc.cdc.gov/travel/destinations/cameroon.htm
Canada http://wwwnc.cdc.gov/travel/destinations/canada.htm
Chile http://wwwnc.cdc.gov/travel/destinations/chile.htm
China http://wwwnc.cdc.gov/travel/destinations/china.htm
Dominican Republic http://wwwnc.cdc.gov/travel/destinations/dominican-republic.htm
Ecuador http://wwwnc.cdc.gov/travel/destinations/ecuador.htm
Fiji http://wwwnc.cdc.gov/travel/destinations/fiji.htm
France http://wwwnc.cdc.gov/travel/destinations/france.htm
Germany http://wwwnc.cdc.gov/travel/destinations/germany.htm
Guatemala http://wwwnc.cdc.gov/travel/destinations/guatemala.htm
India http://wwwnc.cdc.gov/travel/destinations/india.htm
Italy http://wwwnc.cdc.gov/travel/destinations/italy.htm
Japan http://wwwnc.cdc.gov/travel/destinations/japan.htm
Kenya http://wwwnc.cdc.gov/travel/destinations/kenya.htm
Libya http://wwwnc.cdc.gov/travel/destinations/libya.htm
Malaysia http://wwwnc.cdc.gov/travel/destinations/malaysia.htm
Mexico http://wwwnc.cdc.gov/travel/destinations/mexico.htm
Nigeria http://wwwnc.cdc.gov/travel/destinations/nigeria.htm
Panama http://wwwnc.cdc.gov/travel/destinations/panama.htm
Philippines http://wwwnc.cdc.gov/travel/destinations/philippines.htm
Russia http://wwwnc.cdc.gov/travel/destinations/russia.htm
Samoa http://wwwnc.cdc.gov/travel/destinations/samoa.htm
South Africa http://wwwnc.cdc.gov/travel/destinations/south-africa.htm
South Korea http://wwwnc.cdc.gov/travel/destinations/south-korea.htm
Swaziland http://wwwnc.cdc.gov/travel/destinations/swaziland.htm
Thailand http://wwwnc.cdc.gov/travel/destinations/thailand.htm
Turkey http://wwwnc.cdc.gov/travel/destinations/turkey.htm
Uganda http://wwwnc.cdc.gov/travel/destinations/uganda.htm
United Kingdom http://wwwnc.cdc.gov/travel/destinations/united-kingdom.htm
Vietnam http://wwwnc.cdc.gov/travel/destinations/vietnam.htm
Yemen http://wwwnc.cdc.gov/travel/destinations/yemen.htm
Zimbabwe http://wwwnc.cdc.gov/travel/destinations/zimbabwe.htm
If you do not see your place of travel in the links above, below is a link to the Centers for Disease Control and Prevention website where you can find specific immunization information about the place you are visiting.
http://wwwnc.cdc.gov/travel/destinations/list.htm

## Travel Clinics in Bellingham

Western’s Student Health Center has a travel clinic that can provide you with the vaccinations you need.
Call and make an appointment at (360) 650-3400 or go to their website: http://www.wwu.edu/chw/student_health/
You can also go to your regular physician or a walk-in clinic. There is a walk-in clinic located at 4029 Northwest Ave. in Bellingham just off the Northwest Ave. exit off of I-5. For more information regarding what you need to bring with you, call the Walk-in Health Clinic at (360) 734-2330. There is no appointment necessary but make sure you have all the required paperwork and your insurance information.
Paperwork to bring to your travel clinic appointment:
Travel application from your study abroad program
Any records of previous immunizations (including routine vaccines such as tetanus or MMR)
Yellow International Certificate of Vaccination (ICV, if you have one already)
Information regarding any chronic illness you may have
List of allergies
List of current medications

## Enjoyable Eating

One of most exciting experiences of traveling is the privilege of tasting new and different foods. Certain meals or dishes may represent important symbols or be part of significant rituals. Therefore, food can be a great way to learn about other cultures. While you will (hopefully) want to try a variety of meals and morsels, keep in mind that a case of severe food poisoning, or worse, can ruin what would otherwise be a fun and memorable trip.
Consider following before ingesting something new. If you are traveling with a group or someone who is familiar with the regional foodstuffs, chances are slim that you will actually contract some terrible disease from eating. That said, remember that all raw food is at risk for contamination. Eating food from street vendors in cities has shown an elevated incidence of foodborne illness. Seafood is usually riskier to consume, but shellfish should generally be avoided unless someone who has experienced it informs you otherwise. Ingesting tainted shellfish can expose you to ciguatoxin, which can cause diarrhea, nausea, vomiting, abdominal pain as well as respiratory problems. It is best to eat cooked food and avoid diary products.
Often, your best defense against food borne illnesses is your own common sense. If something looks are smells awful, don't eat it. However, it is a good idea to make such judgments before being served or choosing food. Marie Eaton, professor at Fairhaven College, explained that in many cultures, cleaning your plate indicates more than just a good meal. It shows respect for those who prepared the food and for those around you. Leaving food behind can be troubling or offensive in some cases. Especially in areas with increased food insecurity, the concepts of "leftovers" or "giving the rest to the dog" is incomprehensible. In addition to choosing what to eat, remember how you eat and regard the meal is significant, too.

## References

http://www.princeton.edu/~oa/safety/altitude.html http://www.medicinenet.com/script/main/art.asp?articlekey=20512 http://www.butler.edu/global-education/study-abroad/planning-to-go-abroad/health-insurance/ http://traveltips.usatoday.com/temporary-health-insurance-abroad-13384.html http://globaled.us/safeti/v3n1_settle.html http://www.studentsabroad.com/cultureshock.html http://www.wm.edu/offices/revescenter/studyabroad/health/tips/index.php http://travel.state.gov/travel/tips/tips_1232.html http://wwwnc.cdc.gov/travel/