International Medical RotationsHow to set up and prepare for your international experience

By Libby Windell – OMSIVWestern University of Health Sciences - COMP

What drives us to go abroad?

Some Examples for Why We Want to Work Abroad

• Desire to help those in need• Have family or friends there• Love to travel• Want to experience a different health care system• See and treat rare diseases• Learn a new language or improve a foreign

language skill• Broaden your knowledge about the world and

about health care• Help teach• Do Research• Get “hands-on” training without using

conventional diagnostic tools

Now that you’ve decided to do an international rotation, how do you decide where to

go?

Things to Consider before choosing a site:

• Type of Experience you want:• Research oriented• Treatment based• Clinic vs. hospital• Rural vs. urban• Teaching opportunities• Language training• Advocacy and intervention opportunities• Specialty rotation vs. general

More Things to Consider before choosing a site:

• Language Barriers – do you speak the language or will your preceptor speak English?

• Climate – rainy, sunny, hot, humid, cold?

• Infectious diseases – what will you be exposed to?

• Electricity and running water – is this important to you?

• Food and clean/purified water availability

• Political status – is it safe for you to go there?

• Cost of Travel – sponsors, organizations, out of pocket?

• Amount of time working – do you want free time to travel?

University Considerations• What are Your University’s Policies on

International Rotations – What does your school require from you to go abroad and do they have restrictions on certain countries?• Many schools do not allow you to do an

international rotation in a country that is on the US State Department’s List of travel warnings. For a list of these countries, please visit: http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html

• Please contact your university’s International Rotations Coordinator for more information.

Preparation Guides• The Medical Student Guide to Electives Abroad:

• http://www.uch.edu/contentstore/MedicalStudentGuideElectives%20Abroad.doc

• Hope R. The elective pack: a medical student’s guide to essential international health and development. London: International Health and Medical Education Centre, 2004:• http://www.ihmec.ucl.ac.uk/IntHealthElective/Resource_Pack/

ElectivePack.pdf

• A Student’s Guide to International Health and Funding Guide:• http://www.amsa.org/pdf/studguide2ih.pdf

• ToolKit for Going Abroad:• http://www.amsa.org/global/ih/toolkit.ctm

• Advising Medical Students and Residents: International Health Experiences• http://www.globalhealth-ec.org/GHEC/Resources/

IHMECguidebk_resources.htm.

Module 93, GHEC Teaching Modules, 2007

Who Can Help Arrange the International

Experience?

Opportunities – Where to look• Personal Contacts or family members

• Talk with people who live there, have traveled there, or have worked there

• School database• Some schools already have approved international sites

• GHEC – • Global Health Education Consortium GHEC, together with

FAIMER and AAMC, surveyed 127 US and Canadian medical schools to obtain information about the international opportunities they provide for medical students, residents and faculty. From this site you can learn about whichschools offer programs, how these are funded, and in which geographical regions they occur. (http://www.globalhealth-ec.org/, 2007)

• IFMSA - The International Federation of Medical Students' Associations • Offers international exchange programs for medical students

all over the world. http://www.ifmsa.org/

Opportunities – Where to look• SOMA

• Database in the works!

• AMSA List Serve• http://www.amsa.org/global

• NGO’s – Not-for-Profit Government Organizations• Doctor’s without Borders• Liga – Flying Doctors of Mercy• Red Cross• International Medical Teams• DOCares• Etc.

• Faith Based Groups doing Mission Work

• IHOC – International Health Care Opportunities Clearinghouse• http://library.umassmed.edu/ihoc/index.cfm

• Create a New Site!• Contact the country’s Minister of Health and see if you can set up a

rotation.

You still need to

consider…What is my tolerance level!

Can you Handle…• Strange and sometimes uncomfortable

sleeping arrangements• Not being able to have “normal” food• Getting lost in a foreign country or

being stopped and searched by strange guards

• Being exposed to rare and sometimes fatal illnesses

• Following cultural rules• Realizing that you might have limited

ability to help

BUDGET

Funding your Trip

Where to Find Money:• Private donations

• Send letters to friends and family

• Cut back on the home front:• sublet your apartment while you’re gone• Start saving/budgeting months in advance• Cut back on unnecessary spending, aka stop

buying the Starbucks!

• Donations from Religious Affiliations

• Find a program with included amenities• Room and board, transport, etc.

More Places for Money• Grants:

• http://www.grants.gov/• http://www.nmfs.noaa.gov/trade/howtodogrants.htm

• Scholarships• Please check out the SOMA International Medicine

scholarships at www.studentdo.com

• Funding from your COM• Ask your dean, President, Alumni Association, student

clubs, etc.

• Extra Student Loans• Talk with Financial Aide. These trips are for educational

purposes

• Fundraising

Room & Board

How to survive while you’re away

Questions to Ask about Housing Arrangements

• Do you have dormitories for international students? • What are the differences between the dorms specified for

international students verses those for regular students? • Are home stays available? • Are meals included in my housing options? • Is there electricity? Running water? Cooking facilities? Hot

water? • How far are the dorms from the hospital/clinic? • If I have to walk to the hospital, will I feel safe walking? • If I cannot walk to the hospital, is there readily available,

cost effective, and reliable transportation? • Will I feel safe using the public transportation system?

Toolkit for going Abroad, American Medical Association, www.amsa.org

Lodging Examples• Friend or Family in that Country

• Board with someone from the hospital or clinic

• Dorms

• Hotels, hostels

• Rent a furnished apartment

• Bring a tent

Eating in a foreign country• Make sure there is clean water or a

way to purify water at your site• You need to worry about your health too!

• Be prepared to possibly eat strange foods• Bring some antacids, Imodium, etc.

• Be aware of the Cultural norms when applied to eating• E.g. Women may have to eat in another

room, guests of honor might have to take the 1st bite, etc.

Other Hints and Advice• START EARLY!!!!!• Get a travel book and learn more about

the location you plan on going to• Apply to many different sites/programs

• Some trips might get cancelled, so don’t put all your eggs into one basket!

• Be flexible• Be patient – some countries move on a

much different pace• Contact people who have gone before• Check what diseases or illnesses are

common• http://globalatlas.who.int/ (World Health

Organization global atlas

Documentation &

Paperwork

Necessary Documents for Travel• Passport

• If you don’t have one, get one!• Obtaining a passport can take a few months, PLAN

EARLY!!!!• Make a copy, keep in a separate location from your

passport (in case it gets lost)

• Visas• Again plan early. This process can take a very long time!• http://travel.state.gov/visa/visa_1750.html lists which

countries you will need a visa for

• Plane Ticket• www.whichbudget.com (great site for helping you find

low cost airfare)• STAtravel.com

Other Important Paperwork and Supplies

• Health Insurance:• Contact your current insurance to see if they cover you

internationally• Purchase a local plan• Get traveler’s insurance when purchasing your plane ticket – this

often covers health costs.

• Immunizations• Start them now as some require a series of shots over many

months• www.cdc.gov• www.who.org

• Medications• Prophylactic malaria protection• Prophylactic Antibiotics for traveler’s diarrhea• Post-exposure HIV/AIDS prophylaxis – Only if going to an

endemic area• Take your current meds in their original bottles along with note

from your doctor – you don’t want to get stopped at customs!

Packing

What can/should you bring?

The Bare Necessities - Clothing• Be culturally aware! Know what the local

customs are • Don’t think that just because it is ok to wear in

the US that you can get away with it overseas.• Women may have to wear a head scarf or long

skirts, men might not be able to wear shorts – Be aware of the society’s norms!

• Take clothes you would be ok with throwing out – it’s always fun to buy some of the local attire

• Only what you need – in other words you don’t need 12 pairs of shoes!

• Beachwear (again culturally sensitive), rain gear, jackets

• Closed toed shoes

The Bare Necessities – Medical Kit• Latex gloves – take your own box or make sure they have

plenty at your site• Band-Aids• Anti-bacterial, anti-fungal and steroid creams• Hand-sanitizer• Insect repellant• Sunscreen• H2O2• Alcohol swabs• Cotton balls• Gauze• Tape• Epi pen (especially if you have allergies)• Scissors, tweezers, pick-ups• Anti-inflammatory meds (acetaminophen, ibuprophen, etc)• Anti-diarrheals (Imodium, Pepto, etc)• Cold Meds (take pill form, it travels better)• Anti-histamines

Packing – other stuff• Toiletries• Toilet paper• Plastic sacks• Phone cards (Costco sells a cheap international one)• Paper/Pen• Camera• Computer, MP3 player, cell phone

• Bring only if you truly need it• Batteries• Money pouch• Water bottle• Laundry detergent• Flashlight• Books, travel games, deck of cards• Travel journal• Adaptors and converters

Think you’re

ready to go?

There are still a few things to consider!

Cultural Competency!• Culture:

• “set of beliefs, values, artistic, historical, religious characteristics, customs, etc. common to a community or nation.”

• Cultural Diversity:• “the inevitable variety in customs,

attitudes, practices, and behavior that exists among groups of individuals from different ethnic, racial, or national backgrounds who come into contact.”

(Definitions from Stedman's Concise Medical Dictionary, 2007)

Cultural Competency!• You need to examine the various

religious and cultural backgrounds of the country you are traveling to in order to gain a better understanding of them

• You need to know the ethical issues that may arise when modern medicine and religion/culture collide

Examples of Some Religious/Cultural Groups

How their customs and health care

practices may differ

Central and South America• Death and Illness Issues:

• Health care is often scarce some people have little concern for illness/death

• Communication Norms: • Hand and finger gestures

considered rude

• Interpersonal Relationships:• Punctuality is not considered as important• Strong value placed on personal relationships• Male often seen as head of family

• Traditional Medicine• “Botanica” store selling herbs and healing oils• “Curandero”, “Sobador”, “Horchún” Natural Healers

The Middle East

• Death and Illness Issues:• Aligned with Muslim teachings

• Communication Norms:• Finger signals using the left hand are particularly offensive• Shake hands with right hand only!

• Interpersonal Relationships:• Males are generally seen as head of family• Women are often introduced by men and won’t shake hands

• Traditional Medical: • Female physicians often treat women and children• Physicians knock before entering exam room

Resources for Improving your Cultural Competency:• GHEC Teaching Modules:

• Hundreds of Modules created by students, doctors, professors, public health workers, researches, etc.

• User-friendly PowerPoint presentations which can help you prepare for various cultures and practicing health care around the world.

• Will be available Jan. 2008 at http://www.globalhealth-ec.org/

• Conferences:• Osteopathic International Alliance - 1st – 3rd February 2008, London,

England• IFMSA Annual Convention - http://www.ifmsa-usa.org/convention.htm• GHEC Annual Convention - April 3 - 5, 2008, Sacramento, CA • AOA Convention – International Health Symposium, Sunday, Sept. 30th• Check local cultural lectures in your area

• Stanford University On-Line Courses:• Online access to interviews and lectures by nationally

recognized expects in the various fields of international health.• http://med.stanford.edu/oih/library.html

Books, Textbooks• Critical Issues in Global Health (Paperback)

by C. Everett, MD Koop (Editor), Clarence E. Pearson (Editor), M. Roy Schwarz

• Understanding the Global Dimensions of Health (Hardcover) by Anthony Piel (Adapter), A. Michael Davies (Adapter), Bruce Sayers (Adapter), S.W.A. Gunn (Editor), P.B. Mansourian (Editor)

• Essentials of Global Health (Essential Public Health) (Paperback) by Richard Skolnik (Author)

• Other resources:• http://www.globalhealth-ec.org/GHEC/Resources/

GHonline.htm

Ready yet?

GOAL SETTING!• Set realistic, obtainable goals!

•What impact can you really make on a 4-8 week rotation?

•What do you personally want to gain from the experience?

•What do you want others to gain from your experience?

• Reflect before, during, and after your trip

•keep yourself on track with what you want to accomplish

The more prepared you are…• The better your experience will be

• The more help you will be able to provide

• The more rewarding the trip will be

• The better your research will be

• The bigger impact you can make

• The more you will learn

• The more FUN you will have!!!!

Questions?