Travel, Health, and Safety

Planning International Health Rotations

Although providing a detailed overview, this list is not meant to be exhaustive. Please use your own judgment and research in planning for a safe and informative elective.

  1. Create a personal timeline. It is never too early to start planning an international elective. Your international elective should ideally fall during one of your call-free elective blocks in second or third year. At the minimum, you must inform the residency program 4 months prior to your elective. Realistically, we recommend that you begin planning at least 8 – 10 months before your available elective time. This will give you time to work through international travel hurdles (visas, passport issues, etc.)
  2. Formulate personal objectives. Before planning an elective, spend some time thinking about your personal learning objectives and goals for the trip. Do you want to improve your French language skills? Would you like to learn more about public health efforts in Latin America? Are you curious about the delivery of pediatric cardiology services in large cities in Asia? Once you have formulated your objectives, you can begin tailoring your search for an elective towards experiences that can help you meet these objectives.
  3. Discuss elective plans with residency faculty and staff. You may begin by discussing your goals with the GH directors, who will be able to direct you to appropriate resources. The chief residents must be informed, as they will need to troubleshoot any scheduling issues. Program director Dr. Dena Hofkosh must approve all away rotations, and Machele Maus is instrumental in seeking approval from the GME office for the away rotation and helping to obtain necessary documentation required by the host institution.
  4. Choose an elective. Using above personnel and the residency website as a guide, search for an elective which will meet your personal learning objectives. In addition to considering your learning objectives, you should also assess the relative safety of each of the locations you consider. Use the US Department of State website as a guide to review which countries currently have travel advisories. This site is updated frequently, and you should continue monitoring the status of the host country until your time of departure.
  5. Enter into communication with the elective coordinators abroad. Ensure that the timing of your elective will align with the elective offered. Inquire specifically about the elective tasks and opportunities, amount and type of supervision, as well as any documentation required by the medical school, clinic or hospital where you will be working (e.g., medical license, credentials, letter of introduction, etc.). Ensure that your level of language proficiency is appropriate for the experience. It is imperative that there will be professionals abroad who will be supervising you during your away elective. This individual will not only serve as a clinical mentor, but his or her expertise as a cultural broker will be important as well. The nuances of care delivery in another setting are difficult to navigate without help. Use residency personnel to help you gauge whether you will be adequately supervised during the rotation.
  6. Create a budget. International travel is expensive. Be sure that you will have enough funds to cover the airfare, any elective fees that may exist, entry/exit taxes, personal expenses during the elective for food and lodging, and medical preparation (see #8). Review the website for any funding which you may be able to apply for (e.g., AAP travel grant). You should also think about the type of monetary resources you will bring with you. Consider the relative efficacy of traveler’s checks, exchanging currency prior to travel, credit cards, etc, in your country of destination.
  7. Complete international travel documentation.
    1. Valid Passport. Ensure that your passport will be valid through the entirety of your elective (i.e., expires after your date of return). This process can be time-consuming and costly; starting early will help to avoid additional charges for ‘rush passport processing.’ Passport processing information can be found on the State Department website. It is generally wise to keep a copy of your passport, in addition to your actual passport, with you while you travel.
    2. Individual country entry/exit requirements (e.g., entry visa, exit tax, etc.). The US Embassy for each country is the best resource of the most updated information. You can also check each country’s profile on the State Department website.
    3. Registration with the US Consulate. It is recommended that you register with the US Consulate prior to international travel. As per the website: “Travel registration is a free service provided by the U.S. Government to U.S. citizens who are traveling to, or living in, a foreign country. Registration allows you to record information about your upcoming trip abroad that the Department of State can use to assist you in case of an emergency. Americans residing abroad can also get routine information from the nearest U.S. embassy or consulate.” Visit the US Consulate website to complete registration.
  8. Personal medical precautions.
    1. Immunizations and prophylaxis: At least two months prior to travel, consult with your personal physician to determine which immunizations and/or medications you will need prior to or during travel. For example, travelers to Nigeria will need to have typhoid and yellow fever immunizations, as well as to take malaria prophylaxis. Before your visit, consult the CDC travel website to review the recommendations yourself. Plan for these immunizations and medications in your budget, as they can be pricey. The Allegheny Dept of Public Health can administer your travel immunizations, once you determine with your physician which ones you will require. Bring the yellow international immunization booklet with documentation of receipt of recommended immunizations with you. Customs personnel may ask to review this prior to entry or exit from the country.
    2. Medical Insurance: Check with your medical insurance carrier whether your policy will apply overseas and whether it includes medical evacuation coverage. If not, you will need to purchase additional insurance coverage.
    3. Post-exposure prophylaxis: If you are traveling to remote HIV-endemic areas, consider bringing post-exposure prophylaxis with you. You should discuss this option with your personal physician and Children’s Employee Health Services.
  9. Create a packing list. Using information available from your elective personnel, as well as your personal research about the country, make a list of items to bring with you. It is difficult to predict how easy it will be to purchase personal hygiene and care items. For example, you may wish to bring insect repellant, hand sanitizer, gloves, respiratory masks, tissues for use in outdoor toileting facilities, anti-inflammatory medications, headlamp, etc. Recommendations for creating your own ‘travel health kit’ are available online in the CDC Yellow Book. You should make photocopies of your itinerary, passport, visa, contact sheet, etc., and keep these copies in a separate place from the original documents. Consider scanning a copy of your passport and sending to your email account.
  10. Create a communication contact list. Make a list of contact information for yourself, and give a copy to your contacts back home. This should include contact information of the place you will be lodging as well as the facility where you will be working. Also include back-up information in case complications develop: local hotels, the US embassy, transportation resources (bus, taxi), police, etc
  11. Spend time learning about the country and customs. This should be an enjoyable experience – you should be excited to learn more about the country to which you will be traveling! You will be a guest there – it is easiest to be respectful of your hosts if you understand a little about the customs and practices of the country. Travel guidebooks are a good place to start. The US Department of State publishes Field Reports, which also contain useful information. You should try to speak with others who have traveled to that country. For example, the expectation in some countries (e.g., Haiti) is that women should dress modestly in long skirts. Learning about these expectations will likely impact your packing list! In addition, learning to say a few basic phrases in the local language to greet patients and colleagues directly will go a long way.
  12. Have fun and learn a lot! Journaling about your experiences while away is a great way to keep a record of your thoughts and lessons learned. You may wish to document your trip with photographs. If you would like to take pictures, make sure that you bring an inexpensive camera so you won’t be devastated if it is lost or stolen. Also, ask permission before taking pictures of any people. We will be excited to hear all about your adventures upon your safe return!

Additional Suggested Preparation Resources

  • Preparing for Your Overseas Experience, Wayne Hale, MD; UNC Family Medicine
  • Planning and Preparation Guide, Carole Davis, MSW; Ron Pust, MD; Don Wedemeyer, MD; International Health Medical Education Consortium