Different Place, Different Accommodations

While students may have a good sense of managing their disabilities, and often these strategies work well abroad, there may be conditions in the host environment that are hard to anticipate.

The differences in time zones, prescriptions, coursework, noise levels, transportation, and medical services abroad can both positively and negatively impact students when studying abroad. Sometimes advanced preparations are necessary, while at other times a flexible mindset will get students through the experience successfully.

Navigating the Maze of Prescriptions, Airports and Time Zones

For some students with non-apparent disabilities, traveling abroad means learning new skills such as how to acquire enough medications for a long period of time, how to pack for flights and how to adjust prescription-taking to time zone changes. “I thought I was going to have to have my parents ship more medicine to me, so it was really nice when I found out that [Scotland] is on socialized medicine. They gave me all my diabetes medications for free, because I was legally a student there,” says Hailey McKenzie, who was enrolled at a university for an academic year.

Others students have returned home mid-term or relied on their parents to send supplies or medications because their U.S. insurance would only cover up to three months at a time.  When mailing medications, however, parents and others need to be aware of applicable restrictions. “My parents arranged a three-month supply of the medication for the first semester, then I came home at Christmas. Before I left [for my second semester abroad] we reordered more prescriptions,” says Allegra Johnson about her arthritis medications. This visit home allowed her doctor to reassess her condition and add two new prescriptions to her regime, which weren’t available in France.

Differences in medication names, brands, dosages, and regulations about traveling with certain prescriptions are best discovered before leaving for another country.

The differences in medications can make it difficult for those with certain psychiatric conditions or attention deficit/hyperactivity disorder to find what they need overseas because of lack of availability, familiarity or restrictions. “Europeans find it shocking that so many students are taking medications,” says Catharine Scruggs, Program Director of Western Europe at Council on International Educational Exchange (CIEE). “For example, in the Netherlands, they don’t take antibiotics unless they are sick for months. [CIEE Resident Directors] talk about going on the Internet to learn what certain medications are that students are requesting. They usually are not familiar with the things that the students are being medicated for.”

Not all medications that students take are easily supplied in the host countries, according to Kathryn Hanrahan’s experience in talking with local hosts for their Youth for Understanding USA (YFU-USA) exchange students. Differences in medication names, brands, dosages, and regulations about traveling with certain prescriptions are best discovered before leaving for another country. “Insulin is finicky in that it can’t get too hot and can’t get too cold, but you have to keep it in the refrigerator,” explains Chris Opsal, who has diabetes. “The British refrigerator froze, and so the insulin turned solid – I couldn’t inject it if I tried. I had to go into a pharmacy, with no prescription and no doctor, and ask them for what they had. They had to figure out what to give me because they have different suspensions and ratios in England.” Websites listed on our tipsheet on Medications and International Travel can be a starting point in researching one’s medications in different countries.

Photo Caption: Special dietary restrictions can be conveyed to the airlines before traveling, so on-board meals meet one's needs. However, it is always helpful to bring along one's own snacks to make it through the flight and once arriving in the new country.

Students may also have to negotiate pharmacies abroad for other reasons, such as having one’s first episode or disability diagnosis while abroad, or replacing equipment and prescriptions lost while traveling. “I had backup medicine in case my luggage ended up getting lost. On a later trip back to Scotland my luggage was sent to France with a lot of my supplies in it,” says McKenzie who has diabetes. Because she had planned ahead by dispersing her insulin and supplies in different bags, she had an emergency supply with her on the airplane. Packing a full year of medications and supplies, however, is not always practical for carry-on luggage on the airplane.

“After I got my pump, I went back to Scotland and London for a little while. It was a lot easier to travel with a pump,” says McKenzie. “Going through the airport with a pump is a little bit different. In America, most airports that I go through people recognize it now [as a piece of equipment for diabetes], but in Scotland they didn’t know what it was and they wanted me to take it off. They think it is a cell phone or beeper. You need more documentation traveling with some equipment in other countries.”

Passing through airports and considering what to pack on the long flights brings up other concerns. “With a brain injury, orienting yourself while traveling is a huge deal because you can easily get turned around,” says Terese Shelton. Shelton’s son, who has a brain injury, has a Palm pilot with recorded directions and external memory prompts that could assist him to find his way through the airports. Airport escorts can be available to guide individuals through the airport, which can be useful to people with disabilities such as autism, brain injuries or developmental disabilities. In the United States an unticketed parent or personal assistant can receive a permit to pass through security at the originating airport. Some exchange programs may also arrange for all the participants to fly together as a group.

During the international flights, students with non-apparent disabilities may have a few considerations to plan for in advance. One student with panic and anxiety disorders found traveling with someone else on the program helped reassure her on the long flight to England. Crossing time zones may present other challenges such as when to take medication dosages or adjusting sleep schedules. Some travelers start to switch their schedules while in transit, and others change to a new schedule after adjusting to the new time zone. “When I travel, I typically change my insulin timing by a couple of hours every day. I continue this pattern until I am caught up [with the new time zone],” says Opsal who has diabetes. Organizations such as the American Diabetes Association, and experienced travelers with similar conditions can provide guidance on strategies to making the adjustments.

Photo Caption: Travelers with disabilities can call a U.S. toll free hotline to provide assistance in resolving disability-related airline problems -- 1-800-778-4838 or 1-800-455-9880 (TTY). Non-U.S. air carriers are also covered by U.S. law if they stop in the United States.

Medical Costs and Services Abroad

For a more established program, the on-site staff likely has information about medical and emergency services available in the host country and may have even identified specific doctors, counselors or other specialists for their exchange participants to use. Having counselors in place can make a difference in a student being able to make it through the end of a program, says Shelly Shinebarger, a director for disability services at a college in Pennsylvania. This was the case with a student with an eating disorder whose host family in England noticed her declining health; she was connected with a counselor that helped her get through the remaining two weeks of the program.

“We try to have a counselor identified ahead of time who speaks English and is accustomed to working with Americans or westerners,” says Catharine Scruggs, CIEE Program Director. “Also we have a professional on call in the United States who is head of a counseling center at a major U.S. university for our staff to contact with questions about how a student is behaving or [disability-related] needs that come up during the program.” Marta Lukjan, who spent an academic year at a university in Australia, found it helpful to pre-pay for sessions with her home therapist in case she needed to call and have a session over the telephone when abroad.

For students with non-apparent disabilities, it is important to review carefully what health insurance plans cover in advance. Some student’s individual plans in the United States do not cover overseas visits, or international travel. Medical insurance purchased by the student or provided by the program may have a pre-existing condition exclusion defined as “an injury or sickness for which advice or treatment was primarily recommended or received from a physician.” The time period that delineates if a condition is “pre-existing” will vary based on the insurance plan or the exchange organization offering it; typically this can be from two weeks to six months prior to the effective coverage. “Our policy [that we provide to participants as part of CIEE’s program] seems to work,” says Scruggs about the six weeks pre-existing clause in CIEE’s health coverage. “We haven’t seen the issue of students not wanting to go to counseling because it wouldn’t be covered.”

Photo Caption: Students also need to think about how the climate of the host country may impact their health -- is it hot and dry, or wet and cold? Will the sun be more intense?

In countries with socialized medicine, exchange participants may find that the costs of medical services are much less than the United States, which works to their benefit when they have to pay or wait to be reimbursed later by their home insurance. “Medical care in France wasn’t very expensive,” says Allegra Johnson who has arthritis. “I went to the local hospital and it was about US$25-30. In New Jersey, it costs so much more, US$150-300 for a regular visit out of pocket.”

In countries with socialized medicine, exchange participants may find that the costs of medical services are much less than the United States, which works to their benefit when they have to pay or wait to be reimbursed later by their home insurance.

Medical centers abroad may also provide different services than those typically provided in the United States. “When I first got diabetes at age nine,” says Hailey McKenzie, “I would have to poke myself and give a lot a blood. It would take 360 seconds to count down, and then I would match the color of a strip to the back of a bottle scale trying to estimate my blood sugar count. When I went to college in Scotland, I had all this new equipment that would count down in ten seconds, but they were still using this old machine.”  Medical centers in Scotland also had a different conversion system for checking blood sugar levels; what would be a good rating of 100 in the United States, would be 4.5 in the United Kingdom.

Beyond the technological or terminology differences, language and cultural barriers can also enter into the experience of students with systemic disabilities that need health care while abroad.  Having a U.S. doctor write a summary of one’s condition and having it translated can help. For Allegra Johnson, her doctor wrote a detailed report of what did and didn’t work in treating her arthritis, what drugs she was currently taking, and what her problem joints were, and she gave this letter to her rheumatologist in France. Despite this preparation, she still encountered some issues on her doctor’s visit related to language. “It’s challenging when you want to describe your pain and what you’re feeling in a second language. It requires more precision than if you’re saying other things,” says Johnson, who is otherwise quite proficient in French. Another student with epilepsy found that navigating the health system in Germany gave her an opportunity to branch out in her vocabulary and challenge her listening comprehension. Learning vocabulary related to one’s disability ahead of time can be helpful in situations like these abroad.

The impact of common illnesses interacting with medications that students may already be taking can also be an issue. For Jennifer Marshall, she decided to return early when illness from an internal parasite struck during her third study abroad experience. “They told me I could just be treated in Mexico,” Marshall says. “However, due to my previous medical [experiences] it wasn't in my best interest to stay there.” Marshall, like some others with disabilities, had been hospitalized in the past due to a traumatic brain injury, and this influenced her decision to return. Purchasing an airline ticket with an open return date can be useful if there is a possibly one’s health condition may cause an early return, says Marta Lukjan, who has psychiatric and other disabilities and decided to do this for her study abroad program in Australia even though she didn’t end up needing to return early.

Medical centers in Scotland had a different conversion system for checking blood sugar levels; what would be a good rating of 100 in the United States, would be 4.5 in the United Kingdom.

Angela Brown, whose lupus caused many ups and downs during her time abroad, stayed in Spain through the end of the year-long program and traveled Europe afterwards despite fluctuations in her condition. “I was really happy and proud that I managed to [stay for the entire program].  I had actually been diagnosed, right before I went over, and I really didn’t even understand my illness then,” says Brown. “It may be harder and it may be more complicated, depending on your type of disability, but it doesn’t mean you have to give up your dream.”

Transportation Changes

Some students have shared that differences in transportation impacted their experience overseas in small, but meaningful ways. Use of public transportation and more pedestrian zones for walking can impact a student with a non-apparent disability who may be used to having a personal vehicle to get around town. A “short distance” to campus from a host family’s home for the average student may be quite far for students with reduced stamina and increased pain levels, says Lynnett Van Slyke, who encourages students she advises through the University of Pittsburgh’s disability service office to ask specific questions about the program locations they are considering. In one case, an overseas program was able to find alternative housing closer to campus because these distance concerns were revealed during planning prior to the student’s arrival.

Photo Caption: Many study abroad programs do not permit their students to drive while overseas, so subways, buses, bikes and trains are the main way to get around unless students are on a group program where transportation is provided.

On the other hand, a student with diabetes found the amount of walking improved her health. “It was easier to manage my diabetes in Scotland because I had to do more walking; back home in Oklahoma I have to drive everywhere. So, I was getting more exercise and I had to take less insulin,” says McKenzie. “I was eating better too; to save money I was cooking meals and eating more vegetables since that is what is more available.”

The transportation systems in other cities also can be helpful for those with learning, perception or memory issues. Betsy Valnes, who has challenges remembering directions due to a brain injury, found the European cities she visited had one card pass for all public transit, which helped her to keep things straight and organized. Similarly Brennan Rhodes appreciated the transportation system in Spain. “With dyslexia you reverse numbers, which is something I do both inside and outside the classroom. In the Barcelona transportation system, the routes are marked in colors and numbers, so you have the option of remembering either,” says Rhodes.

Taking Extra Time

For people with learning disabilities or attention deficit/hyperactivity disorder, finding quiet time to focus on homework or taking extra time to read their textbooks in the absence of usual accommodations, can mean additional time management challenges abroad. “Studying abroad was more difficult because in Lithuania it was harder to find quiet places to study. The school was very small, basically three rooms, so there was nowhere to go and hide to study,” says Paula Gieselman, who has ADD. “I had to learn time management better because anytime I found somewhere that was reasonably quiet I had to take the opportunity. I had to allow more time for studying because I couldn’t concentrate as well when it was louder.”

Kristin Faudree, who has a learning disability, typically used extended time on tests or audio tapes for the required reading material as a student in the United States, but did not have these accommodations during her study abroad trips. She spent extra time reading aloud to herself to help learn the materials. “In Chile, I really struggled in confidence. I was with college classmates and they were picking things up quicker than I was; they would go out at night and I’d have to stay home and finish my work,” says Faudree. “I wasn’t expecting the workload. I was going to class, then had to go to an internship and somehow find time to do my homework, which took me longer than everyone else. I had to teach myself to study with noise going on in the background and that was difficult. I didn’t use earplugs, but it probably would have been a good idea.”

Photo Caption: Less insulation in buildings, more activity in the streets, and classes held during field trips can all lead to more distractions than students are used to at home.

Jennifer Marshall, who has a cognitive disability related to a brain injury, also didn’t have her preferred accommodations abroad. “In the United States, I have a digital tape recorder so that I can record my lectures, download them onto my computer, and then play them back from the computer. In London I did not have a computer, and thus [relied on] a mini tape recorder and [cassette] tapes,” says Marshall. “This extra effort meant that on the weekends and nights when the other students would go out, I needed to make decisions about being a college student – living up the experience abroad and also tending to my academic responsibilities. At that time I didn't know that it was possible to have a reduced class load, and I wanted to fit in as much as possible (I was still a freshman). This past year I have been on a reduced course schedule, and I realize that it would have been helpful while I was in London, too.”

“Because my home college just transfers credits and not grades, I just had to pass. A lot of stress was decreased by that fact alone.” Lisa Baum

According to Catharine Scruggs, whose organization sends thousands of students abroad, most students with learning disabilities do not exercise the option to take extra time on tests or to request a private room for test taking. “I probably could have used extended time on tests, but I didn’t ask for it. It didn’t impact my grades too much,” says Lisa Baum, who has dyslexia and studied in London. “Because my home college just transfers credits and not grades, I just had to pass. A lot of stress was decreased by that fact alone.”

School is Different Over Here

Class load, course structure or the university setting can be very similar to the United States in some countries, especially if the program is faculty-led or the instructor is American. For classes taught by professors from the host country, however, the experience may be very different.

“I met a great professor at University of Leeds in England, and the accommodations there are excellent. They see a need for cognitive accommodations, and are more attuned to individualized education and meeting the needs of the student compared to the United States where the student needs to meets the needs of the classroom,” said Betsy Valnes, who has a brain injury. “In the United States it’s difficult to identify to professors what is appropriate cognitively, but I’ve been extremely thankful for some of the communications I’ve had in England.”

“The United States and Europe are advanced in how they handle students with learning disabilities, but in other countries, like the Latin American countries I went to, learning disabilities are just not dealt with unless the programs set accommodations up outside the school or have someone in-country to assist students,” reflects Faudree, who has dyslexia and researched more on this topic as a graduate student. Students have a right to choose any destination even if they understand it may be challenging, however talking to others with similar disabilities or alumni of the program may assist in better anticipating what cultural factors may come into play.

Photo Caption: The cultural aspects of the program can provide new understanding about the host country and show some of the similarities between people around the world in a way that a textbook often cannot do on its own. 

For students with AD/HD, as Jonathon Kull learned while he was enrolled at a school in Japan, the differences in educational expectations may affect students in ways typical accommodations, such as extended time on tests, don’t address.

“I find that in America there is more understanding for disabled students. If you’re late three minutes you can make up a test instead of taking an ‘F’; if you lose a sheet of paper they don’t say, ‘Find it on your own from another student,’ they will just give me another copy because they understand that I lost the sheet of paper. It felt that the professors in Japan felt I was perhaps doing it on purpose or that I didn’t have a disability,” says Kull, who chose to return home a semester early due to these issues with his professors. “You didn’t get to pick your own schedule, so I was sitting in the classroom from 9 am to 12:30 pm – it was difficult for me to just sit there and focus without any breaks. I would be sitting in the classroom repeating to myself  ‘Don’t walk out of the room – just sit here and tolerate it’ and then, just acting on an impulse, I would be already out of the room. I explained to them I didn’t mean to do this on purpose, and they said ‘Just try your best.’ They didn’t offer me any solution until the last two weeks of the term and then it was too late.”

For students with AD/HD, as Jonathon Kull learned while he was enrolled at a school in Japan, the differences in educational expectations may affect students in ways typical accommodations, such as extended time on tests, don’t address.

Kull also discovered that the Japanese educational system required a lot of self-study instead of specific assignments, which made it hard for him to understand what he should focus on. Tests also covered more chapters than he was used to at home. Unfortunately, he wasn’t able to get the academic and disability-related support he needed during the professors’ office hours, and didn’t know that contacting his home university in Iowa could have provided him some assistance.

“I try to stay in touch with our students throughout their stay,” says Lisa Baum, who is a study abroad advisor at San Jose State University. “For some of them, it’s a mental block because I’m on the other side of the world, and they feel like I’m not accessible. But, with email I can get back to them within 12 hours. Usually I can find something to help them from here.”

Paula Gieselman, who has the same disability as Kull, experienced similar course structuring as a study abroad student enrolled at a university in Lithuania. “For the Lithuanian professors, they have a list of 15 books as suggested reading, and they will take information from those books for tests, yet they never really assign any specific readings to prepare [for the tests]. It was impossible to do all of that reading, and it was difficult knowing what they expected,” says Gieselman. “I tried to go over the headers, introductory paragraphs and conclusions of each chapter, so it gave me an idea of what different things might come up on a test. I wouldn’t have had time to do more because I’m such a slow reader – it’s just part of my disability.” Unlike Kull, she found her professors helped her when she sought them out during their office hours. Also, her professors provided her note taking and extended time accommodations to account for extra distractions caused by background noises during classes.

Photo Caption: In some countries overseas, higher education is available only to those who receive top marks on qualifying exams and second chances are rarely given.

“I think I had too much of an expectation,” reflects Kull. “If your grades aren’t [what you expected] when you study abroad, don’t worry about it because it’s really an experience to live in a new country. The lessons that you learn outside of class and about yourself are going to triple the amount that you’re going to learn inside of classroom. I’m definitely a changed person for the rest of my life.”

Summary

For students with non-apparent disabilities, encountering disability-related differences between the host and home cultures such as accessing medical services, prescriptions and transportation, or learning in a different educational system may mean advocating for different types of accommodations that may not be needed at home. It may also mean adjusting one’s mindset or expectations, and putting in extra time to plan ahead for extra workloads or personal time.

In classes taught by host country professors, students may find long reading lists of suggested readings without specific assignments or they may discover that there are more distractions when studying because of less insulated walls or classes conducted outdoors. Requesting reduced course loads, using earplugs when studying or finding programs that provide pass-fail grading options are all ideas students wish they had considered.

In many cases, ways of doing things in other countries are beneficial for students with disabilities. Transportation systems may be easier to navigate and medical services may be less expensive. Classes may be structured in a more student-centered way that improves learning and courses may be less demanding.

Students with non-apparent disabilities can talk with alumni, investigate support services ahead of time, and learn about cross-cultural disability issues in the host country to identify early on the specific questions that need to be answered in advance. For unexpected differences encountered abroad, students also can call upon their U.S. based study abroad office, doctor or counselor to provide assistance remotely, so that the study abroad experience is successful and rewarding.

Helpful Suggestions to Prepare for Unfamiliar Places:

1. Before leaving, research individual prescriptions and the rules about mailing and refills in the countries where you will be traveling. 
2. Travelers with disabilities can call a U.S. toll free hotline to provide assistance in resolving disability-related airline problems -- 1-800-778-4838 or 1-800-455-9880 (TTY).
3. It is important to have all documentation when traveling with some equipment.
4. On-site staff has information about medical and emergency services for those who ask.
5. Health insurance plans differ greatly, so check in advance.
6. Medical centers abroad may provide different services, and dosages than those typically provided in the United States.
7. Having a U.S. doctor write a summary of one’s condition and having it translated can help cut down on miscommunications dues to language barriers. Learning vocabulary related to one’s disability ahead of time can be helpful as well.
8. Purchasing an airline ticket with an open return date can be useful if there is a possibly one’s health condition may cause an early return.
9. Ask specific questions about the program locations because the definition of short walk in some countries differs greatly with the American definition.
10. Some study abroad experiences are hindered because students have difficulty finding a place that is quiet and easy to focus. Consider reduced course schedules and earplugs.
11. Talking to others with similar disabilities or alumni of the program may assist in better anticipating where best to travel.