IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

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What to do and where to go? A doctor’s advice for students abroad

Imagine: You’re a student, excited to study abroad. You arrive in your new home away from home, ready for a semester of learning and exploring. New people, new places, new culture – but something isn’t right, you don’t feel well. Alone in a new place, you think, “my symptoms aren’t very serious, I don’t need a doctor”. But your condition is getting worse, and you don’t speak the language or know where to go.

For a 20-year-old student from San Francisco, her stay in Rome took an unexpected turn last year when she began to experience symptoms of cough, tiredness, and difficulty swallowing. All the signs pointed towards a common cold, but she was actually suffering from a rare and life-threatening heart condition. Thankfully Dr. Francesco-Maria Serino and his colleagues diagnosed and treated the student in time; however, this situation highlights the need for more accessible healthcare services for students studying abroad.

Dr. Serino is an IAMAT-affiliated doctor and founder of Doctors in Italy, a website that connects patients to English-speaking doctors in Rome. In 2018, he co-founded the Doctors in Italy Association, a non-profit organization aimed at eliminating language barriers and making healthcare accessible to travellers. Each year, Dr. Serino and his network of practitioners provide medical care to international and local patients in need.

For this blog, we had the pleasure of asking Dr. Serino about this unusual case, how students can prepare for their trip, and how they can access healthcare while abroad.

From your experience, what are the common reasons students abroad seek medical care?

Long-term travellers, such as study abroad students, usually seek medical assistance to diagnose and treat acute conditions that cannot wait until their return. For students taking a semester abroad or pursuing a degree in Italy, regular checks, flu shots, yearly physicals, STI screenings, gym certificates and other preventive medicine measures are also frequently needed during their time in Italy.

Additionally, adjustment difficulties and cultural shock can cause or exacerbate pre-existing mental health conditions while abroad. There is a substantial need for qualified mental health professionals able to communicate fluently in English. We receive a large number of requests across Italy for mental health assistance from students studying abroad, their families and their college advisors. Study abroad programs and schools usually offer counselling assistance, though students may prefer to have independent access to external resources. Just like with any other condition, underestimating early signs can lead to a crisis situation which is always more dangerous and harder to manage.

What challenges do students face when navigating a foreign healthcare system?

The majority of study abroad students come to Italy without speaking Italian therefore their main barrier to appropriate assistance is certainly due to language. They rely almost exclusively on their local school advisors for directions and suggestions for doctors and clinics. University advisors have the huge responsibility of selecting qualified medical providers, a very challenging duty. In particular, outside of the bigger cities where many branch campuses and island programs are located, finding English-speaking doctors can be a daunting task.

Some students are not comfortable asking university staff for advice, especially when it has to do with STI issues, gynecological and urological conditions, or mental health. They usually search elsewhere for a suitable provider and it’s important to give them the tools for finding reliable providers on their own.

Tell us about the recent case of the student who fell ill and reached out to Doctors in Italy.

This is a case that touched us a lot. A bright and enthusiastic 20-year-old American study abroad student in Rome contacted us for what she described as cold-like symptoms and mild fatigue. As it was over the weekend, my colleague visited her in her dorm room. The treatment had worked over a few days and she recovered quickly.

Two weeks later, she messaged us again while she was out of the country for a weekend getaway in Eastern Europe. She reported persistent weakness and mild chest discomfort which she described as “feeling like my heart is weak”. We arranged for her to be examined by a cardiologist upon her return.

When she came to the office, she appeared healthy, positive and relaxed, just a bit tired. The physical examination with the cardiologist was mostly unremarkable, except for low blood pressure. Although the EKG showed only mild nonspecific abnormalities, the cardiologist decided to perform an echocardiogram which showed that her heart was pumping a reduced proportion of blood with each heartbeat (a condition known as low ejection fraction). Within 30 minutes she was admitted to the hospital under the care of an outstanding and English-speaking cardiology team.

A few hours later, her condition worsened dramatically; she had a severe arrhythmia (irregular heartbeat) with loss of consciousness which required defibrillation. She was kept for 20 days in the cardiology intensive care unit where she was diagnosed with Epstein-Barr myocarditis, quite a rare condition in a healthy young person. After being cleared for travel, she went back to the US with her family where she is currently under the care of her cardiologist.

What would her outcome be if she had not found an English-speaking doctor?

If she had not been already at the hospital when the arrhythmia occurred, monitored and surrounded by expert doctors, she wouldn’t have had a chance. This case is a prime example of the reasons why the ability to communicate effectively and understand the patient is crucial. There were no reasons for concern except for the patient’s detailed description of her symptoms – her vitals were good and were not suggestive of a cardiac condition. If she had to deal with doctors who did not speak English, how else would she have described a sense of weakness of the heart in some specific positions? Had she not been able to convey this to the doctor, a diagnosis wouldn’t have been reached in time.

What can students do before they depart to prepare for their trip?

Before departure, students should work with their study abroad office to get informed about the healthcare system and resources at their destination. For long-term travellers especially, it’s important to research in advance for global and local networks of English-speaking doctors to rely on.

It’s also a good idea to sign up for travel health insurance that covers the trip, checking carefully that it includes all the areas you will be travelling to (for example, insurance plans for students may cover them while in the study abroad destination, but not for weekend getaways to other countries). If staying more than a month, it’s best to pick a policy that includes mental health assistance and outpatient consultations for non-emergency conditions – student insurance plans are often very affordable.

Medical assistance in Italy is not particularly expensive, however, for a self-funded student on a budget, not having direct insurance coverage may limit access to healthcare and lead to a delay in proper care. For those who do have an insurance plan, it’s important to be informed on how to use it and where it can be accepted as a form of direct payment. My advice for parents choosing an insurance plan for their kids is to select a policy that also covers regular outpatient consultations and to educate them on how to use it. Without this reassurance, students may worry about paying out-of-pocket and not see a doctor until their condition has become more serious and harder to treat.

To help long-term travellers such as students, au pairs and expatriates who face the challenge of signing up to the Italian public healthcare, it’s best to read some up-to-date guides prepared by locals, such as this detailed guide in English prepared by our team after extensive research on the topic.

For students with a pre-existing condition, what are some key things to do before departure?

If you have a chronic condition, make sure to bring copies of all relevant medical reports and prescriptions. It will help the local healthcare providers understand your medical history and provide you with the best possible medical assistance for the time you are abroad. Choose a travel health insurance that also covers pre-existing conditions, to avoid surprises when it’s too late.

Another way to ease your mind is to bring enough of any medicine not available in Italy that you need to take regularly, avoiding to leave it all in your checked luggage where it can be delayed or lost. Bring a copy of your prescription to show customs and transit security that the medication is for your personal use. Once you arrive in Italy, it’s very hard to receive a shipment from home as customs block all imported medications and delay their delivery.

Drug restrictions and availability vary greatly among countries, and if you are not prepared you may end up needing to interrupt a treatment if there is no viable local alternative. In the case of long-term mental health treatment, this can have severe results. A common request we receive is for methylphenidate (Ritalin), which in Italy is prescribed and administered only with a therapeutic plan issued by very few specialized centres.

What should students do if they require medical attention and they don’t speak the language?

First of all, do some research. Learn when it’s appropriate (and not) to use the emergency services. The Italian regional agency for healthcare services provides information in English about public emergency assistance.

If needed, students can call the local emergency number and ask for an ambulance or take a taxi to the closest public hospital that has an emergency room open 24/7. Though language barriers can be an issue, no private medical facility can match a public emergency room in dealing with a serious and life-threatening condition.

For non-emergency conditions, students are better off making an appointment with a qualified primary care physician or medical specialist who can take the time to examine them and is better suited to provide follow-up care.

If they are in a bigger city and are looking for a free or inexpensive option, students can also look for public walk-in clinics, usually located in tourist areas.

In Italy emergency medical assistance is provided to anyone without regards to their nationality, usually at no cost or at a very low fee, except in case of admission. In this case the final cost may end up being higher than in a private facility as public hospitals do not provide itemized bills, usually required by insurance companies to issue a refund.

Are you planning to study abroad? Before you go, check out these resources:

Travel and Mental Health Series – for helpful tips and advice on managing stress, anxiety, and travelling with a pre-existing mental health condition.

Travel Health Insurance Guides and Resources – to help you choose the right travel health insurance plan for you.

IAMAT Medical Directory – contains contact information for English-speaking doctors in over 80 countries around the world.

Travel Health Planner – an online tool that provides health advice tailored to your itinerary.

Image by: Abby Chung from Pexels

Article by: Claire Westmacott & Jacqueline Tucci