Health and Safety

Students are strongly encouraged to have a comprehensive pre-travel consultation with a physician. This should include an assessment of the student’s health and immunization history, length of program, destination country, activities and other travel the student will undertake while abroad. The consultation should also cover the following:

• Country and region specific health and environmental information
• A plan for continued treatment while abroad
• Gender-specific health information
• Required, recommended and routine vaccinations
• Recommended prophylactic and self-treatment medications and first aid kit (see Travel Health Kits)
• Advice and resources for students with special needs, including specific plans for students with preexisting conditions that include provisions for medications, ongoing care and emergency treatment
• Information about physiological and psychological consequences students may encounter as a result of culture shock or changes in routine
• General advice on nutrition and dietary deficiencies
• Cautions about alcohol and drug use and a specific plan for those with preexisting dependency issues
• Rabies education (avoid feeding or petting animals, and post-exposure measures)
• Blood borne pathogens precautions (needles, blood products, tattoos, piercings, surgeries, acupuncture) and safe sex (including emergency contraception)
• General instructions for emergency medical situations, including locating a physician abroad
• Illness and accident insurance policies and emergency assistance coverage information, including medical and evacuation insurance (See International Health Insurance Information section below)
• Pre-travel medical and dental exams and treatment as indicated

Check the Centers for Disease Control and Prevention (CDC) website to research what, if any, immunizations and/or medical tests are routine, recommended or required for your host country location(s).

It is your responsibility to obtain any immunizations and/or medical tests before you travel abroad. Be aware that some immunizations require more than one dose spread over time, so do not wait until the last minute to check on your immunization needs.

The U.S. Department of State website contains government-sponsored information regarding travel abroad, individual country profiles, travel alerts, travel warnings and worldwide cautions. We strongly encourage you to review this information and take advantage of the following Department of State links and services:

• The Students Abroad website provides government-sponsored information about study abroad.
• Register with the Smart Traveler Enrollment Program (STEP) to provide the Department of State with information that can be used to better assist you in the case of an emergency.
• Visit the U.S. Embassy main website to find embassy and consulate locations worldwide.
• The Smart Traveler app available on iTunes provides country-specific information, travel alerts, travel warnings and access to the U.S. Department of State Facebook and Twitter accounts. You can access your STEP profile from the app and create new travel itineraries from your iPhone, iPod or iPad.

• Stay alert and be aware of your surroundings.  Situational awareness is the best defense!
• Don’t go out alone. The most important safety tip is to always go out with at least one other person.
• That said, realize that you are easily identified as an American in large groups and might be targeted for that reason. You can minimize risks and avoid obvious dangers by keeping a low profile, and not identifying yourself as American by dress, speech, or behavior. Avoid loud conversations or arguments.
• Be especially cautious at night.
• Don’t use short cuts, narrow alleys or poorly lit streets.
• Make sure to always lock your doors. Meet visitors in the lobby.
• Do not leave money and other valuables exposed in your room while you are out. Use a safe if one is available.
• Take the same precautions as you would in any large city. Do not give out your name or address and do not share program information with strangers. Do not discuss travel plans or other personal matters with strangers.
• If you are out late at night, let someone know when you expect to return.
• Know where the nearest police stations and hospitals are, and keep emergency numbers handy.
• Do not go into unsafe or unknown areas.
• Be especially cautious in or avoid areas where you may be more easily victimized. These include crowded subways, train stations, elevators, tourist sites, market places, festivals and crime-ridden neighborhoods.
• Avoid scam artists by being wary of strangers who approach you and offer to be your guide or sell something at bargain prices.
• Beware of pickpockets. They often have an accomplice who will: jostle you, distract you, or create a disturbance. Beware of groups of children who create a distraction while picking your pocket.
• Wear the shoulder strap of your bag across your chest and walk with the bag away from the curb to avoid drive-by purse-snatchers.
• If you are confronted, don’t fight back – give up your valuables.
• Avoid participating in demonstrations and other political activities. Demonstrations that  are intended to be peaceful can turn violent
• Try to seem purposeful when you move about.  Even if you are lost, act as if you know where you are going. Try to ask for directions only from individuals in authority or store employees.
• Review information on driving and road safety overseas.
• Do not get on an elevator if there is a suspicious-looking person inside.
• Read the fire safety instructions in your room. Know how to report a fire, and be sure you know where the nearest fire exits and alternate exits are located.
• If a country has a pattern of tourists being targeted by criminals on public transport, that information is mentioned in the Country Specific Information published by the U.S. Department of State in the section about crime.
• Only take taxis clearly identified with official markings. Beware of unmarked cabs. If they have a meter, make sure they turn it on. If they do not have a meter, ask in advance how much the journey will cost.
• Well-organized, systematic robbery of passengers on trains along popular tourist routes is a problem.  It is more common at night and especially overnight.
• Where possible, lock your compartment. If it cannot be locked securely, take turns sleeping in shifts with your traveling companions. If that is not possible, stay awake. If you must sleep unprotected, tie down your luggage and secure your valuables.
• Be aware that the same type of criminal activity found on a train can be found on a public bus on a popular tourist route.

Elon University’s practice is to enroll all international travelers on University-approved programs in mandatory iNext international insurance. Some programs abroad may require additional insurance policies. The international health insurance policy covers students ONLY while they are outside of the United States, and the policy is terminated upon return to the United States.

Learn more about iNext insurance for Elon University

Everyone has mental health! Students are encouraged to expect adjustment difficulties and predetermine their unique strategy and coping mechanisms for achieving and maintaining balance.

Travel Anxiety and Stress Reduction

• Regardless of how you are traveling, leave early enough so you do not feel rushed and can deal with delays such as traffic or long lines.
• Limit your alcohol, sugar and caffeine intake, which can exacerbate anxiety. Drink plenty of water.
• When you feel anxious, practice “four square breathing.” For each count of four: breathe in deeply, hold; let breath all the way out through pursed lips; and take a cleansing breath. Repeat. You’ll find that each time you breathe all the way out, you will be breathing out some of your anxiety, and feeling more relaxed.
• Meditation, yoga, coloring in adult coloring books or mandalas are ways in which some students are able to reduce their stress load. Think about packing coloring books, mandalas, markers or colored pencils in your carry on. There are free mindfulness apps that you can download here before you leave.
• Try to maintain a reasonable schedule and diet. Changes in sleep in diet can have a significant effect on your emotional well-being, and traveling to a different culture often entails such changes.
• Make sure to bring a list of emergency contacts with you. This list could have contact information for all of your support resources (family members, friends, pharmacy, all treatment providers, etc.)

• Be aware of the attitudes towards mental illness in the culture you are visiting. Whether you decide to be very private or very open about your own mental health issues, you can use this opportunity to learn about how different cultures think about mental well-being and mental illness.
• Don’t be surprised if you experience strong emotional reactions to being in a very new and different place. It can feel very strange to be far from everyone you know and everything you are used to. You may feel anxious, or homesick, or frustrated, or fearful, or self-conscious, in ways that are quite unlike your usual self. Such “culture shock” is often a normal and temporary reaction to new surroundings. If you feel you need some emotional support as you get adjusted, or you feel your emotional reactions are more severe than a normal adjustment phase, seek out the help of a someone who you know you can trust; a host parent, a teacher, professor, or your program administrator.
• For comfort, bring a photo of a loved one with you, or a favorite object to remind you of home. Don’t bring anything that you couldn’t stand being lost or stolen. Keep a journal. Send lots of letters home describing your new surroundings.
• Introduce yourself to others and try to strike up pleasant relationships, even in the face of language difficulties. Friendship can be a wonderful cure for culture shock.

• If you are in therapy and plan to spend enough time in one location abroad that you want to continue your therapy there, work in advance to locate a provider. A U.S.-trained provider is preferable, for the continuity of your care and to minimize language problems. Your insurance company, your program abroad, the U.S. embassy in that location or your current therapist are good resources to ask for the names and contact information of local providers.
• It may helpful for your current therapist to be in touch with your therapist abroad, ask your current therapist if you need to sign a release before you go. You may be able to sign such a release even if you don’t yet know the name of your new therapist abroad.
• Carry with you the number of the local U.S. embassy, your program director, a family member and your current therapist, in case you need to reach someone in an emergency.

• Check to confirm your prescription medication is allowed in the country to which you are traveling.  It is critical for this to be confirmed before you leave so you can work with your treatment provider on how to handle this if your prescriptions are not allowed or illegal.
• Take medications with you in your carry-on luggage, not in checked luggage. That way, if your luggage is lost or your plane is delayed, you will still have access to your medications.
• Bring a copy of the prescription or some other documentation identifying the medications as legitimately yours. If possible, keep your medication in its original bottle, which has the correct label and instructions.
• Keep a note in a separate place from your medications, listing the name, dose, and other instructions related to your medications, along with your own physician’s and pharmacist’s phone numbers. That way, if your medications are lost, you will have the information you need to obtain a new supply as quickly as possible.
• As much as possible, keep your medications in a cool, dry place that is safe from children and from theft.
• Bring enough medications to last the program, or make arrangements in advance for how you will refill the prescription while you are abroad. For example, you may need to find out: Are there pharmacy services where you will be? Is your medication available there? Will you be able to use your U.S. insurance? Your U.S. prescription? Is it legal to have medications mailed to you there? How reliable is the governmental mail service and are other carriers available (e.g., FedEx)?
• Remember the effect and effectiveness of your medications can change with changes in stress, diet, and climate. Even if you have been stable and doing well on your medications, plan in advance what you will do if your medications become problematic and you need psychiatric services while you are abroad.
• Maintain your medication schedule – even if it is inconvenient while you are on the road. Remember the schedule of medication may also change as time zones change – ask your treatment provider to advise you on how to adjust your medication schedule to a new time zone.
• Check whether the local tap water is safe before using it to take medications. If the local water is not safe to drink, use bottled water or bottled soda (unless otherwise indicated by your prescription).
• If you are going to be abroad a significant amount of time and are not able to speak with your treatment provider over the phone, Skype, FaceTime, etc. try to locate a provider abroad – a U.S.-trained provider is preferable, for the continuity of your care and to minimize language problems. Your treatment provider, insurance company, program abroad, or the U.S. embassy in that location, are good places to ask for the names and contact information of local providers.

Tip: Review this OSAC resource on traveling with medication.

Food and water contamination is one of the leading causes of illness for travelers. Basic precautions can minimize the risk of diarrhea and other illnesses. Specific food and water recommendations depend on the destination country. In most developing countries, the only safe sources of water are factory-sealed bottles or water that has been purified (see Water Disinfection for Travelers).

• Avoid ice in drinks, as the ice may have been made with unsafe water.
• Cooked foods should be eaten hot.
• Raw fruits and vegetables should be eaten only if they have been washed in clean water or peeled by the traveler.
• Poor refrigeration, undercooked meat and food purchased from street vendors could pose problems related to food contamination.

See Food and Water Precautions for more information.

Travelers may also wish to download CDC’s TravWell app for during-travel guidance.

If you have allergies, reactions to certain medications, foods or insect bites, or other unique medical problems, it is strongly suggested that you disclose this information.

• You may also want to consider wearing a “medical alert” bracelet.
• Talk with your doctor to determine what the required medical treatment for your allergies should be.
• You may also wish to carry a letter from your physician explaining any necessary treatment.
• If you take over-the-counter allergy medication, you will want to research the availability of your medicine abroad.

Tip: Learn how to say what you are allergic to and describe your allergic reaction in the language of your host country.

If you have dietary restrictions, it is strongly suggested you disclose this information. Your program advisor/manager can discuss any food limitations or restrictions in an advising appointment or during the program-specific orientation. Research the food available in your host country, and do not assume that the food you want or are used to eating will be readily available.

Tip: Learning how to say what your dietary restrictions are in the country’s host language will help you to obtain the food you can eat and avoid the food you cannot.

Elon provides access to an app called My SSP by Morneau Sheppell for all semester program participants. MY SSP tailors to the unique needs of students studying abroad by providing:

• Immediate support 24/7, by telephone 001.416.380.6578 (When calling outside of North America students can call collect or request a call back to not incur long distance charges)
• Access to Master’s level Counselors experienced in supporting students studying abroad

Yes, even at 3am.   My SSP provides confidential support 24 hours a day, 7 days a week.

With remote access, students do not have to go anywhere – they can call or chat with a counselor from wherever they choose.

Confidential.  Participation and what is shared with the counselor is not shared with anyone – unless the students decide to tell someone on their own.

My SSP can help address common concerns such as:

• Adapting to a new culture
• Being successful at school or placement
• Relationships with friends and family
• Stress, anxiety, sadness, loneliness and much more!

The rules and regulations of the host country, city, region, and institution may differ from those at home. Students should be counseled that they must abide by the legal system of their host country. Additional information on host country laws may be found on the Department of State website.

• You MUST obey the local laws of the host country in which you’re studying.
• An arrest or accident during a term abroad can result in a difficult and expensive legal situation.
• It makes no difference if you did not know the law.
• Your U.S. citizenship does not protect you from full prosecution.
• Many countries impose harsh penalties for violations that would be considered minor in the U.S., and you may be considered guilty until proven innocent.
• In many countries, you can be detained for photographing security-related institutions, such as police and military installations, government buildings, airports, border areas and transportation facilities. If you are in doubt, ask permission before taking photographs. You should also ask permission before taking photographs of local people.
• Don’t accept packages from anyone, regardless of what may be offered or what story you are told. You could miss your flight, your exams, or several years of your life behind bars.

If you find yourself in a legal jam, contact the closest U.S. Embassy or Consulate for assistance. U.S. Consular employees cannot arrange for local officials to release detained American citizens. Elon University will also be unable to assist or intervene on your behalf. Don’t get yourself in trouble and stay away from others engaged in questionable behavior.

• Do not carry much cash, and try to keep smaller bills available.
• Do not flash large amounts of money, at any time.
• Make sure your credit card is returned to you after each transaction.
• Deal only with authorized agents when you exchange money or buy tickets.
• If your possessions are lost or stolen, report the loss immediately to the local police. Keep a copy of the police report for insurance claims.

Traffic crashes are a major cause of injury to students while traveling abroad. Vehicular traffic is not always regulated to the extent it is in the United States, and traffic laws may differ. For instance, students should be made aware of countries where traffic travels on the left side of the road instead of the right as in the United States. If not aware, students may look in the wrong direction for oncoming traffic and risk being hit by a car.

Students should also be counseled to choose safe and legitimate modes of travel in their destination countries. Each US Department of State country information sheet includes “Traffic Safety and Road Conditions” content to help assess conditions in a specific country. A good source of information on transportation safety is the Association for Safe International Road Travel.

Be careful and informed about water safety before approaching unfamiliar bodies of water. Do not to swim alone or on beaches where there are no lifeguards or warning signs.

Swimming in contaminated water can put you at risk for contracting certain infectious diseases. Be aware of common water-borne pathogens, especially those in freshwater.

Students should think about building safety at their destination, including the potential impact of earthquakes, wind damage or flooding, and substandard building standards or maintenance practices. Fire safety is of particular concern. Students should evaluate buildings for the presence of functioning smoke alarms, fire extinguishers, emergency ladders, and fire exits.

Air pollution is a problem in many cities around the world and can exacerbate symptoms for students with chronic health conditions. Even if students are healthy, they may experience temporary symptoms such as irritation of the eyes, nose, and throat; coughing; phlegm; chest tightness; and shortness of breath.

There are risk factors associated with the use of needles, blood products, tattoos, piercing, surgeries and acupuncture. In addition to the risk of contaminated needles, the water used to create tattoo ink is often shared and can be contaminated with blood-borne pathogens.

Be prepared. Practice safe sex (bring adequate condoms, birth control, and emergency contraception). Educate yourself on social customs of host location(s) with regard to dating, public displays of affection and sexual intimacy.

Stay informed of any political unrest that may take place in your city or country. Avoid participating in demonstrations and other political activities. There may be an increased risk of anti-American activity during periods of political conflict. Even demonstrations that are intended to be peaceful can sometimes turn violent, and you don’t want to be arrested for involvement even if you just happen to be there.

Sexual harassment occurs abroad, just as it does in the U.S. Even if you have never experienced sexual harassment before, know that in some countries street harassment such as shouting obscenities, comments on your appearance or dress or other verbal or nonverbal sexual harassment may be a cultural norm. Sexual harassment laws also differ from country to country. The country in which you study may not consider unwanted sexual attention harassment even if it would clearly be harassment in the U.S., or if other people (including local people) might consider it a problem. Therefore, the safest way to manage unwanted sexual attention is to immediately distance yourself from the individual or situation, speak up in a clear and firm manner when possible, and, most importantly, report the incident immediately to your program administrator or housing coordinator.  Please remember that reporting the incident helps keep you and others safe.

Be aware that some men may mistake friendliness for romantic interest. If you feel that someone is misunderstanding you, distance yourself from them immediately and connect with someone from your group. Dress in ways that are culturally appropriate for the country in which you are studying. Never accept drinks from strangers.  If you put your drink down and leave it – even for a minute – throw it away. Never invite people you do not know to your apartment. Even if you know someone, use caution when hosting anyone not in your program in your apartment. Again, making sure that you are never alone with someone helps keep you safer.

Having a full and engaged experience while studying abroad is important and can be threatened by negative experiences. Sexual violence and relationship violence are traumatic events that can destroy your term abroad. Many of us don’t think about potential dangers and the contexts that aggravate certain crimes in other countries. Sexual and relationship violence are never your fault. To reduce the possibility of sexual or relationship violence, there are some important points to remember. The perception that American women and men are very sexually active, heavy partiers (i.e. liberally consume alcohol and other drugs), and want to have romantic or sexual relationships with people from other countries are common in other parts of the world. While these stereotypes most likely comes from the prevalence of glamorized TV and movies, and may surprise you, they need to be taken seriously in order to reduce the potential for harm. Thus it is even more important for students studying abroad to be educated and aware about the issue and context of sexual and relationship violence.

Things to think about while studying abroad:

• Talking about sex or sexual encounters may be interpreted as a “come on”.
• Dancing in clubs may also be interpreted as a “come on”.
• Though hitchhiking may be more common in other cultures, it carries the same dangers that it would in the United States, including sexual harassment, sexual assault or other mental or physical harm.
• Kissing a friend “goodbye” or “hello” has different meanings in different cultures. Before performing these behaviors be sure that you are communicating appropriately in the cultural environment where you are studying.
• Be firm and assertive when you say NO. Be clear and direct to be certain that your intention and the words are understood.
• If someone is making you uncomfortable then leave the situation. Ideally, find someone in your group and stick with that person. If necessary go to your program administrator or apartment manager. You do not have to stay in an uncomfortable situation.
• Be aware that things which may appear as normal to you, such as getting drunk or asking someone to walk you home, may be misinterpreted based on other cultural norms. Know that your actions are going to be interpreted in ways you may not intend.
• Know that even when you say NO, certain people will not respect your words. Sexual violence is not your fault in any context. Sometimes people are too afraid to say NO.
• Recognize that, unfortunately, sometimes sexual or relationship violence can even happen among students from the U.S. studying abroad. Take precautions when considering a romantic or sexual relationship with a fellow U.S. student as well.
• If something happens to you, it is NOT your fault. Know that there are people and resources at Elon here to help you. Seek support and information as soon as possible.

Violence against women is a growing concern all over the world. Sexual violence is prevalent in all cultures. Sometimes when students are out of a familiar environment, they are even more vulnerable to these crimes. Please remember that if someone commits one of these crimes against you, you are not responsible.

Any student may call the Coordinator for Violence Response via SafeLine at 336-278-3333 for help. Speaking with the Coordinator for Violence Response is COMPLETELY confidential. She will not call your parents unless you want help speaking with them about the incident. She will not share information with any other University administration unless you give permission first. The Coordinator for Violence Response is available to support you in the way you feel best during your experience, if you decide to return home and when you return to the Elon campus.

Regardless of the laws of your host country, use of any drug, by an Elon student may result in termination from the program at the student’s own expense. Elon University can assume no responsibility for you if you are arrested for drug use. Do not put yourself or others at risk. Something that might be considered a misdemeanor in the US could be seen as a felony in another country. Laws concerning drugs may be much more stringent, and penalties, more severe, in countries other than in the United States. Being a citizen of the United States does not matter. You are subject to the laws of the country you are in. The U.S. Consulate cannot get you released if you are arrested. They can only help notify family and arrange a lawyer. All Elon students are held to the academic and social policies of the Elon University Honor Code and Student Handbook.

Drinking ages vary from country to country, but excessive drinking is inappropriate in all countries. Excessive drinking can lead to serious consequences, including dismissal from the program. Moreover, all cultures consider drunkenness as socially unacceptable. If you do drink, do so responsibly and in moderation.

• Avoid obvious risks (e.g., do not swim where a lifeguard is not present).
• Know the local emergency phone numbers.
• Know the first point of contact for safety on-site.
• Inform program or university staff of personal travel during term and contact information during that travel.
• Know the safety protocol for treating sexual assault survivors. Is it safe to go to the police? Are sexual assault survivors advised to visit the police in all locations?
• Plan for fire and carbon monoxide safety.
• Know how to handle medications abroad.
• Know where to go and whom to call for hospitalization abroad.
• Pack a backpack of essential items if evacuation is likely due to a crisis.