Traveling Abroad

1. Gillian Ice, Ph.D., M.P.H. Christina Gonzalez OMS4 Traveling Abroad

2. Overview of Global Health Prior Preparations Reading Before You Leave Packing The Journey Protecting your safety, health, mental health Panel Discussion Culture and Culture Shock Reflection Objectives

3. International Health is more than the study of diseases of the developing world: it is the study of the many factors that contribute to health and disease world-wide. • Conceptualizing health as the end point of such complex processes involves looking at economic, cultural, historical, political, commercial and environmental factors on a global scale: the subject therefore benefits from the input of many other disciplines. What is International Health?

4. 2 elements • Open borders ↑ flow of goods, services, finance, people and ideas across international borders (i.e. our trips) • Changes in institutional and policy regimes at the international and national levels that facilitate or promote flow (i.e. AMA, AOA ↑ practice scope) • As the process accelerates, the health of individuals is increasingly dependent on global as well as local processes. With new solutions, come new problems and challenges, particularly in the developing world. The world is being transformed by globalization

5. Improving communications technologies - alert to the outbreak of a disease & to share information on health issues. • Growing trade, tourism and migration, which facilitate the spread of infectious disease and anti-microbial resistance. • Global environmental change and the illicit drugs trade, which are global phenomena outside the control of any one government and have an impact on health. Globalization and Health?

6. The increasing mobility of health professionals across borders The increasing mobility of health consumers (i.e. patients traveling abroad to access medical care) The increase in private companies, including foreign companies, which provide health services and health insurance schemes. The use of new technologies, such as the Internet, to provide health services across borders and to remote regions within countries.

7. Health professionals working in the field therefore benefit enormously from an understanding of the factors underlying health as well as clinical skills and knowledge. Such awareness also enables doctors to act as advocates for the health of people in distant parts of the world, and to appreciate the global factors relevant to their practice of medicine at home. creative international thinking

8. Health for All: • 134 health ministries in 1978 • To Attain Health Security for all • To achieve global health equity • To increase healthy life expectancy • To ensure access for all to essential health care of good equality Global Health Declaration

9. Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality and empower women • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria, and other diseases • Ensure environmental sustainability • Develop a global partnership for development • http://www.un.org/millenniumgoals/global.shtml WHO Millennium Goals 2015

10. Agricultural improvements • Investments in basic health care • Investments in education • Power, transport, and communication services • Safe drinking water and sanitation • http://www.rideforworldhealth.org/lectures/Poverty_And_Health.pdf Solutions? : The Big five

11. Presence or absence of barriers: • Physical barriers such as supply, availability, distance • Economic or financial – direct and indirect costs • Cultural barriers – perception of health services such as discrimination or language barriers Recognition of the universal right to health Access to Heath Care

12. How do we play into this? Good Question!!

13. Traveling Abroad:Prior preparations While abroad, you are bound to the Ohio University Student Code of Conduct, all laws of the host country, program rules and regulations, and the Conditions of Participation that you signed in the program application. Legal Drinking Age Drug Use Legal Rights Non-Compliance Financial Responsibilities/other responsibilities in the student code of conduct

14. Fill out all of the necessary paperwork and return to Mary Protect your finances and your identity READ – OUCOM’s Pre-departure Preparation Section Protect yourself and your group! Traveling Abroad:Prior preparations

15. Traveling Abroad:Prior preparations • Travel Safety • http://www.oucom.ohiou.edu/International/TravelSafety.htm • Know your destination • http://www.oucom.ohiou.edu/International/CountryEducation.htm • Health Information • Immunizations • Travel Medical Kits • http://www.oucom.ohiou.edu/International/KeepingYourselfHealthy.htm

16. Read required and recommended texts provided by programs • Read about your destination • Explore additional topics of health in developing countries • http://www.oucom.ohiou.edu/International/MedicalClinicalKnowledge.htm Traveling Abroad:Reading BEFORE you leave

17. Essentials • Packing List • Medication • Passport / money / etc. • Clothes • Clinic supplies • Water bottles • Hand sanitizer • Camera / film / digital storage • Comfort items • What can you buy there? • Squeezing it all in • lay it all out, take away ½ • Lay that ½ out & take away ½ Traveling Abroad: Do I really need all that stuff?

18. Get to the airport early Change of clothes, hygiene items ↓ETOH ↑ ↑ H2O Traveling Abroad:The journey

19. At the airport Be prepared for a bit of a shock Talk to your program director about money exchange Flexible concepts of time Traveling Abroad: Once you’ve arrived

20. DON’T TAKE EXPENSIVE JEWELRY or ANYTHING WITH WHICH YOU CANNOT PART!!!! • Follow your directors instructions about where you can and cannot go. • General safety tips • Keep your passport and essential documents LOCKED in your hotel room • Money belt • Don’t flaunt money or equipment • Locked backpack • Walk in pairs, don’t walk at night • Don’t give street children money Traveling Abroad:Protecting your safety

21. Traveling Abroad: Emergency Action Plan Know who to contact & how to reach them: Faculty director / official in-country program contact Parents, guardians, or family Office of Education Abroad/OUPD HTH or other health insurance carrier US embassy/local police Know where to go: Your nearest emergency contact and the best mode of transport to get there Emergency medical facilities (check with directors and HTH website or with host country coordinator) Various transportation facilities (airport, train station, etc.) Have access to money: Diversify your money (credit card, cash, travelers checks, debit card) Do not carry all your money in one place. Separate it in safe places.

22. Take your prophylaxis!!! Avoid mosquitoes NO WATER NO RAW VEGETABLES / FRUIT Universal precautions are no joke! Wash your water bottle frequently Purell - wash your hands Be prepared for diarrhea Have a TB test pre & post trip Ride a bike taxi at your own risk Don’t swim unless you’ve been instructed that it is safe Traveling Abroad: Protecting your physical health

23. Traveling Abroad: Health Promotion Alcohol and Drugs Drinking may be culturally appropriate at times, but binge drinking is not safe and does not give others a good perception of Americans Engage in low-risk drinking Safe Sex Bring condoms and latex with you Americans are often perceived as “easy”in other cultures Sexual Assault Be aware of your surroundings; where you go with whom Don’t assume other Americans are safe

24. Lariam vs Malarone • You will experience challenging things • Ways to cope • Talk to people • Take a break • Journal - Reflection • Take time to have fun Traveling Abroad:Protecting your mental health

25. Panel Discussion • Questions???

26. “Their” culture, “My” culture”, “One culture?” • Culture (def) - The totality of socially transmitted behavior patterns, acts, beliefs, institutions, and all other products of human work and thought • The Global Village – increased contact between cultures, identities and views = modern communications and travel (+) • Homogenization??? Traveling Abroad: Culture

27. Traveling Abroad: Culture • Ethnocentricity • Naïve Realism • Cultural Generalizations

28. Traveling Abroad: Iceberg of Culture Food, dress, music, visual arts, drama, crafts, dance, literature, language, celebrations, games Courtesy, conversational patterns, concept of time personal space, rules of conduct, facial expressions, nonverbal communication, body language, touching, eye contact, patterns of handling emotions, notions of modesty, concept of beauty, courtship practices, notions of leadership, tempo of work, concepts of food, ideals of childrearing, theory of disease, nature of friendships, tone of voice, attitudes toward elders, concept of cleanliness, patterns of group decision-making, definition of insanity, preference for competition or cooperation, tolerance of physical pain. concept of self, concept of past and future, definition of obscenity, attitudes toward dependents, problem-solving roles in relation to age, sex, class, occupation http://www.doe.in.gov/lmmp/pdf/iceburgofculture.pdf

29. Traveling Abroad: Culture Shock First stage-Everything is new and exciting. The honeymoon phase. Second stage-Frustration in trying to adapt. Culture stress and eventually shock. Third stage-The turning point. You gain understanding and start to feel positive. Fourth stage- Integration into the culture. Recognition that the new culture has much to offer. Fifth stage-Re-entry shock. Some experience difficulty returning to own culture. Culture Shock Curve Click here ↑

30. Traveling Abroad:The fun stuff

31. Be careful not to get too many souvenirs • Consider giving field assistants clothing, medicine etc. • Pack carefully • Items you can’t bring back to the US • Agricultural products • Animal products • Biological agents • Be prepared for reverse culture shock • GIVE US YOUR FEEDBACK!! Traveling Abroad:Traveling home

32. Traveling Abroad: Reflection • What to do with your experience abroad upon returning home: • Presentations to other students • Keep your eyes open regarding how this experience has affected your practice of healthcare/ research • Advertise on your resume • Articles

33. http://www.who.int/trade/glossary/en/ http://www.un.org/millenniumgoals/global.shtml http://www.rideforworldhealth.org/lectures/Poverty_And_Health.pdf http://www.doe.in.gov/lmmp/pdf/iceburgofculture.pdf Ohio University BobCats Abroad and the Office of Study Abroad References