Helping International Students in Medical Crisis

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Helping International Students in Medical Crisis

• What Advisors Can Do

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Illness

• Illness makes people feel isolated
• Illness makes people feel powerless
• Illness makes people feel afraid
• People experiencing illness may have cultural
  expectations of treatment support that are
  difficult to provide in the context of pursuing
  education abroad.

3
Defining Medical Crisis

• Beyond the services provided by your student
  health/counseling center
• Any health care needed as a result of
  violence/trauma
• Any medical condition that prevents a student
  from performing IADLs (instrumental activities of
  daily living) or ADLs (activities of daily
  living)

4
Instrumental Activities of Daily Living

• These activities allow us to live independently
• Shopping
• Preparing meals
• Housekeeping
• Doing laundry
• Using transportation
• Managing medications
• Managing finances
• Using the telephone

5
Activities of Daily Living

• Obvious critical need of outside help if
  student is unable to
• Maintaining continence
• Eating
• Getting in and out of bed
• Using the toilet
• Bathing
• Dressing

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4 Levels of Medical Crisis

• Level 1 Condition requires Urgent Care/ER
  visit, but no hospitalization. No IADL or ADL
  impediment.
• Level 2 Condition requires hospitalization. No
  IADL or ADL impediment upon hospital discharge.
• Level 3 Condition requires hospitalization.
  IADLs are impaired after hospital discharge
• Level 4 Condition requires hospitalization.
  IADLs and ADLs both impaired after hospital
  discharge.

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Typical Level 1 Needs

• Interpretation services
• Translated forms/documents
• Assistance accessing medical records overseas
• Transportation to medical facility
• Advocacy Companionship
• Assistance Filling Prescription
• Assistance Completing Insurance Claim
• Assistance Arranging Follow-up Appointment/s
• Possible dependent family member needs!
• Child care transportation

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Typical Level 2 Needs

• All Level 1 Needs, plus
• Reduced Courseload Authorization
• Additional companionship
• Hospital Service Assessment
• Appropriate Meals
• Appropriate Care
• Appropriate Religious Opportunities
• Dependent Needs
• Childcare (Day or 24-hour)
• Transportation for hospital visits
• Transportation to school

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Typical Level 3 Needs

• All Level 1 2 Needs, plus
• Temporary Disability Services on Campus
• Assistance performing IADLs in residence
• Possible visit from family overseas
• The best option may be to return home!

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Typical Level 4 Needs

• All Level 1, 2, and 3 Needs, plus
• Nursing facility care
• In-home Health Aide to assist with ADLs
• Visit from family overseas
• The best option may be to return home!

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Ready, Willing, Able

• What are you and your institution ready to do?
  (preparation groundwork)
• What are you and your institution willing to do?
  (staffing levels, personal investment, political
  will)
• What are you and your institution able to do?
  (legally, ethically)

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The Three Ps

• Pre-Crisis Planning Target is Institution
• Pre-Crisis Preparation Target is
  Office/Department/Division
• Pre-Crisis Programming Target is
  Student/Community/External Resource

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Pre-Crisis Planning

• Review Emergency Management Plan
• What is your chain of command? Where do you fit
  in?
• Who is authorized to speak for the university to
  medical providers? To the press? To the
  family/overseas institution/authorities?
• What steps are typically taken when a student is
  injured/killed? Will these steps need adaptation
  in the case of an international student?
• Is your plan effective for all members of your
  international population? J-1 Faculty? OPT
  students? LEP students? Branch Campus students?

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Pre-Crisis Planning - Insurance

• Know your school policy inside out!
• What is your lifetime benefit ceiling? Is
  additional major medical available?
• Will your policy cover pre-existing conditions?
  What if they are undiagnosed until adulthood
  (congenital defects)?
• Is your coverage mandatory or optional? How are
  students guided towards making insurance
  decisions?
• When does your plan start to supply coverage?
• Are all students types of students (e.g. OPT)
  covered?
• Is there a minimum enrollment?
• What acts will invalidate medical insurance?
  Suicide? Drug overdose? Extreme sports?

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School Insurance Coverage

• 2006/2007 Wording
• International students, visiting faculty members,
  scholars or other persons with a current passport
  or student visa (F-1, J-1 or M-1 visa) who have
  not been granted permanent residency status and
  who are registered for (6) six or more credit
  hours are required to be insured under the
  Student Health Insurance Plan
• 2007/2008 Wording
• International students and scholars
  registered/enrolled with VISA status (F-1, J-1 or
  M-1) who have not been granted permanent
  residency are required to be insured under this
  plan.

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Pre-Crisis Planning Emergency Services
Membership?

• Will your membership fly relatives in from
  overseas if student is hospitalized?
• Will your membership fly student home? If so, how
  does it work?
• Will your membership provide child care to
  students minor dependents? Escort dependent
  children to home country?
• Will your membership lend money to student in
  medical crisis?

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Pre-Crisis Planning Family Non-Local
Sponsoring Institutions

• How will you access an interpreter if needed?
• Who notifies family non-local sponsors?
• What assistance is offered by the university?
• Is there a guest suite on campus? Will the
  university arrange/pay for housing?
• Can someone meet them at airport and transport
  them to student?
• Can you assist/speed visa processing?
• Can you arrange for interpreter?

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Pre-Crisis Preparation Pre-Arrival

• Consider having students submit similar forms as
  those completed by your universitys outbound
  students.
• Medical Dietary Report
• Desired/Undesirable Treatment Notes
• Risk Liability Waivers
• Make sure students bring medical records with
  them in ENGLISH.

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Pre-Crisis Preparation - Orientation

• Make sure to get copies of student health
  insurance policies and contact information for
  file.
• Get a Privacy Waiver for file with name of
  emergency contact/s and language spoken!
• Make sure students understand what acts may
  invalidate their health insurance!
• Make sure students applying for drivers licenses
  understand organ donation authorization
  questions.

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Pre-Crisis Preparation Medical Providers

• Make a list of local medical providers who
• Have telephone translating available in office
• Are willing to deal with unfamiliar insurance
• Dont seem like theyre about to choke on it
• Maybe who speak a second language themselves
• Visit your local hospital they have social
  workers and chaplains. Get to know them and their
  services.

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Pre-Crisis Preparation

• Find out which health care providers serve
  migrant workers and refugees oftentimes they
  are a great resource!
• Create a recourse with your findings to keep in
  your workplace.

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Worst-case Scenarios

• Can US embassy expedite family members travel?
• Can students embassy assist with emergency
  contact? Family emergency travel? Repatriation of
  remains?
• Do you know a local mortuary that can be
  culturally sensitive? A local cemetery?

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Pre-Crisis Programming -- Caring
Committee/Community Volunteers

• Send/deliver greeting card
• Cook meals, if at home sick
• Visit hospital, if hospitalized
• Rent videos from home country deliver
• Play board games
• Hand-held video games
• Magazines (good choice for LEP students)

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Pre-Crisis Programming Medical Provider Outreach

• Offer provider trainings, if you feel you have
  expertise in intercultural communication.
• Does your school offer programs in health care?
  Can you build connections for future need?
• Physical Therapy
• Occupational Therapy
• Physicians Assistant
• Pharmacy
• Registered Nurse
• Licenced Practical Nurse

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Personal Considerations
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Gatekeeping

• A students medical condition may not present as
  a crisis to you/your staff
• Dont be a gatekeeper let the student determine
  level of need/services required.
• Gatekeeping puts you between the student and
  medical care and thats not a responsibility
  Id like to have!

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Transportation

• Our university policy is that students in medical
  need are not transported by university staff.
• Were in a rural location, and too much can go
  wrong between us and the hospital, even in what
  seem to be non-urgent cases.
• We have made an arrangement for non-urgent
  cases to be transported by a local taxi company.
  The university covers the immediate cost, and
  bills the students account making sure that
  money doesnt stand in the way of transportation
  to medical care.

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Culturally Appropriate Health Care

• Were not medical professionals
• Were cultural interaction coaches
• Liase between medical provider/facility patient
  to help minimize cultural conflicts
• A young, Saudi mother is hospitalized due to a
  ruptured appendix. She will be in the hospital
  for 2 weeks. How can we help minimize cultural
  conflict during her stay?

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Cultural Considerations

• Appropriate food medication
• Culturally
• Religiously
• Appropriate care
• Mixed-gender practitioner/patient dyads
• Mixed-gender advisor/student dyads!
• Assumptions made about ability to pay
• Long-term short-term health considerations

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Systemic Challenges

• For students from countries with national
  health, it may be difficult to accept/adapt to
• Paying for health care
• Insurance coverages, deductables, forms
• Missing incomplete medical records
• Students can become frustrated trying to
  reconstitute medical records from memory.
• Medical providers can be frustrated by incomplete
  records and clueless students.
• Unfamiliar conditions
• Tropical diseases
• favism G6PD Deficiency
• Mongolian spots
• LEP students may not be getting good
  interpretation services

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Situational Challenges

• For students still in their teens, this may be
  the first time they have been expected to manage
  their own health/health care.
• Students with dependents may be managing someone
  elses health care for the first time in a
  foreign country

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How Involved Do You Get?

• Would you visit a hospitalized student?
• Would you be in the room for an exam?
• Would you hold a students hand?
• What role would you play for a spouse/dependent
  child in crisis?
• Think READY WILLING ABLE

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Deep Water

• If you have chosen to accompany student
• Explain what comes next
• Be there for the student not for the clinicians
• WATCH, LISTEN, and remember. Sanity-check what
  youre hearing/observing.
• Check for clear communication. If you know the
  student doesnt understand, get students
  confirmation, stop and ask the clinician to say
  that again.
• Treatment needs to meet/exceed what youd want a
  family member to have. Maintain high standards!

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During a Medical Exam/Procedure

• Give the patient as much control as possible.
• Provide the patient with as much choice as
  possible.
• View the patient as an expert about him/herself.
  Ask what might help reduce stress during
  procedures.
• Take a break during the procedures if necessary.
• Engage in dialogue throughout exam.
• Check in regularly throughout the exam about the
  patient's level of anxiety, if at all possible.
• Ask clinician to explain why a procedure is being
  done.
• Use distraction during the exam to reduce the
  patients stress.