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A No Good Very Bad Day without Adderall

Christine Sprovieri, Ed.D.

Senior Director, Office of Global Travel Operations, Risk & Resilience

Brown University

Jenn Fullick, Ph.D.

Associate Vice President

Health, Safety and Wellbeing

IFSA

jharford@miusa.org

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Session Takeaways

Using location as a tool for decision-making related to prescription medication needs
Overview of current trends and restrictions to advise travelers related to prescription medication
Cadre of useful and accessible resources for advising travelers on medications abroad
Useful backwards planning approach on developing a strategy for travelers to successfully navigate prescription medication needs while abroad
Sensitizing travelers to connectivism and how to create “nodes” and “links” to accessing salient resources while abroad

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Overview of the current state of advising on medication abroad

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What are some of the common challenges you see when advising travelers about medication abroad?

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Considerations

In gauging risk variables for traveling with medication abroad, we need to think about the following:

Access
Availability
Quantity - Duration of time abroad
Legality
Portability

The challenge regarding the capacity to advise within the context of medications abroad is the impossibility of having full knowledge of barriers to accessing all medications in all countries where your students may travel.

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Considerations (2)

“Medication access is a complex, multidimensional issue that must consider not only patient-specific challenges, but also health system limitations, among others”

OTC vs. prescription
Restrictions
Host destination(s)
Beyond the medication: injection treatments and durable medical equipment (e.g., CPAP)

Holland, L., Nelson, M., Westrich, K., Campbell, P., & Pickering, M. (2021). The patient’s medication access journey: a conceptual framework focused beyond adherence. Journal of Managed Care Speciality Pharmacy, 27(12), 1627-1635.

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Misconceptions vs. reality: why planning ahead is key

Students don’t understand that they may not be able to have access
Students may think it is easy to get an appointment as soon as they arrive and script will be ready immediately
Some conditions are not treated the same or by the same type of doctor
Some students may also need to be treated virtually (or at least in part) and this could involve a prescriber/doctor in a different location than which the student is studying

Certain medications (prescription and OTC) may not be available at all in the host country
They may have to wait several weeks for an appointment
Some doctors may prescribe more (or less) than what we see in U.S.
This could create misalignment with what they prescribe and what is available and legal onsite

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Options for advising

General approach

Hands off

Specific (detailed by country)

The Forum’s Standards of Good Practice for Education Abroad indicates, at a minimum, you should prepare students prior to departure with “information related to accessing physical, mental, and emotional health and well-being services,” while “recognizing that not all countries have in place the same support and infrastructure.”

The Forum on Education Abroad. (2020). Standards of Good Practice for Education Abroad, Sixth Edition. doi.org/10.36366/S.978-1-95236-02-3

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Timing is everything: why planning ahead is key

Especially with regard to determining if medication is available AND legal
In some cases students may need to work with their primary care physician or mental health provider in the U.S. to switch medication or create an alternate “while abroad” plan; this could take time to adjust
Some insurance providers require forms be completed, in advance, for maintenance medication or to treat certain chronic conditions needing medication administration (e.g., Crohn’s)
Allowing time to obtain required import certificates, depending on quantity or type of medication

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What is “Connectivism” and How is it Useful in Advising Students Traveling Abroad?

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Connectivism approach to advising

What is connectivism in relation to supporting travelers with medication?

Nodes and links approach to advising

“Elephant and rider” holistic approach to empowering students on managing medication abroad

Christine

Connectivism is a “relatively” new learning theory (began in the 1980s) that encourages open dialogue, collaboration, network connections, and the creation of “nodes” and “links” to accessing salient resources and sifting through the “noise” of what is not useful.

Connectivism emphasizes the significance of networks and connections in learning. It posits that knowledge exists in the world rather than solely in individuals, and that learning involves the ability to navigate and utilize these networks effectively. Learners are encouraged to seek information across various platforms, engage with diverse perspectives, and continuously adapt their understanding in response to new information.

Connectivism underscores the importance of critical thinking, network navigation skills, and staying current with evolving information landscapes. It's particularly relevant in today's digital age, where access to information and the ability to make meaningful connections are paramount for learning and growth.

Student populations today are very interconnected and “plugged in” with social media and online resources.

The key with connectivism is not that we want to teach travelers everything they need to know or prepare for but teach them how to connect to their support networks and find information themselves or get support while abroad.

Sound simple?

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Who are the rider and the elephant?

Credit: Dirksen, J. (2024). Talk to the elephant: Design learning for behavior change. New Riders: Voices that Matter.

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But what do you do when students know what to do, but still aren’t doing it?

Credit: Dirksen, J. (2024). Talk to the elephant: Design learning for behavior change. New Riders: Voices that Matter.

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Information overload?

Credit: Dirksen, J. (2024). Talk to the elephant: Design learning for behavior change. New Riders: Voices that Matter.

Christine

Students are often being inundated with information before departure. Packing, logistics, booking travel, transfer credit requirements, etc. Some of it sticks, some of it they are distracted away from because they have so much going on.

Because bringing medication abroad can have serious consequences–both for their personal health and safety as well as legal implications–it is imperative that we speak to both the “rider and the elephant” when addressing repercussions and steps students need to take before they leave their home campus.

Speaking to both the rider and the elephant can also be enhanced by using connectivism. So instead of feeling like we need to fill the rider’s plate with “some really important compliance information” where we risk the elephant drifting away to see “what’s over there,” we can teach students how to find the information and get connected to their support network before they leave campus for their global opportunity.

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How can I use connectivism to advise students about traveling with medication? (1)

Using and Building Networks and Resources	Encourage students to utilize various networks and resources available to gather information about traveling with medication. This includes consulting with healthcare providers, pharmacists, campus partners like Health and Wellness or Counseling and Psychological Services, and online communities dedicated to travel and health.
Information Filtering	Talk to students about how to filter and evaluate information about traveling with medication from the internet and other sources. Highlight the importance of reliable sources such as official government websites (e.g., TSA guidelines in the US, International Narcotics Control Board website), reputable travel health websites (e.g., CDC), and embassy websites of the host country(ies).
Self-advocating	Discuss with students the importance of advocating for themselves when it comes to their personal health and wellness. Encourage them to talk to you/campus partners and onsite supporters well in advance of travel.
Network Navigation	Guide students on how to navigate the networks of regulations and requirements related to transporting medication across borders. This includes understanding customs regulations, documentation requirements (such as prescriptions and doctor's notes), pre-arrival forms, and restrictions on certain medications in their host country(ies).

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How can I use connectivism to advise students about traveling with medication? (2)

Creating Connections	Help students make connections between their specific medical needs and the practical aspects of travel. Encourage them to discuss their plans with their healthcare providers to get individual advice on managing their medications while abroad.
Ethical Considerations	Discuss ethical considerations related to traveling with medication, such as respecting local regulations and customs, ensuring the legality of carrying certain medications abroad, and being mindful of cultural differences in perceptions of medication.
Keeping apprised	Emphasize the importance of continually remaining apprised when it comes to traveling abroad with medication. Advise students about staying updated on changes in regulations and recommendations, especially if they are traveling to multiple countries or for longer study abroad periods, like semester-to full year programs.

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But what if they still don’t get it?

Credit: Dirksen, J. (2024). Talk to the elephant: Design learning for behavior change. New Riders: Voices that Matter.

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How can I best advise students?

Appeal to Emotions:

Acknowledge and address student concerns and emotions related to traveling with medication. Use anecdotes or real-life scenarios to connect emotionally and illustrate the importance of understanding medication regulations.

Highlight Personal Relevance:

Emphasize why understanding and complying with regulations are personally relevant for their health and study abroad experience. Show how advance preparation can prevent complications at customs and ensure uninterrupted access to necessary medications.

Provide Practical Guidance:

Break down complex regulations into clear, actionable steps. Use visual aids, checklists, or infographics to simplify information about carrying medications across borders. Demonstrate the importance of documentation like prescriptions and doctor's notes. And taking everything in their carry-on luggage!

Use Stories and Scenarios:

Incorporate storytelling or realistic scenarios where travelers face medication-related challenges abroad. Guide students through decision-making processes, encouraging them to consider legal, health, and practical implications.

Encourage Self-Efficacy:

Empower students by providing resources and strategies for proactive planning. Encourage them to seek out reliable information, consult healthcare providers, and advocate for their health needs while traveling. Facilitate discussions where students can share concerns and strategies, which will promote a supportive learning environment.

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Practical Resources and Creative Solutions

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Creative (and legal!) solutions for obtaining medication

Timing travel to obtain more medication and travel with permitted amount
Immunology - Doctors sharing ‘recipe’ in advance and can be made abroad
Be aware of alternatives before you go abroad or while abroad - discuss with doctor

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Creative ways to educate and outreach to students

Weave into pre-departure sessions and advising the importance of being proactive
Sending reminders to students well-before arrival
If applicable, engaging your emergency assistance provider to make appointment arrangements, before departure, so consultations are set up for students upon arrival
At onsite orientation – assist in making appointments

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Leveraging avenues of support

Health insurance - home institution, personal insurance

Third party providers

Emergency support services

Local or in-country support

Jenn

Health Insurance: Students may not be aware and assume that they are only able to use one insurance plan and related services while abroad, which is not necessarily the case. Explore with the student their personal and institutional insurance options, and relevant support services, which may include advising on medications while abroad and options for securing additional prescriptions, quantities, and appointments with prescribing physicians abroad, in advance of travel. (See Chapter 33 in this volume by Joan Rupar 2024 for more information on international health insurance.)

Third-Party Education Abroad Provider Organizations: Some education abroad program provider organizations have specialized staff to support the health and safety of students abroad. Many have long-standing working relationships with local physicians and other experts equipped to navigate specialized requests.

Emergency Support Services: Providers of 24-hour or crisis response frequently have experience in obtaining medication and prescription refills globally. Contact them well in advance of travel to inquire about how to access.

Local/in-country support: Non-Government Organizations (NGOs) or other partners abroad may have experience in specific medications and restrictions locally.

Local Healthcare/Nationalized Systems and Resources: Some countries may have publicly available resources and support worth exploring.

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Useful and Practical Resources

Website–governmental

Emergency/crisis support provider services

On-site services

Health insurance support services

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Advising Resources