Judi Shaw, MD. – Shaw Medical Travel Consultants

DIVERSITY, INCLUSION AND CULTURAL COMPETENCE.

In recent times we’ve heard a lot about diversity and inclusion and we’ve also heard a lot about cultural competence. Unfortunately, these terms are often conflated and used interchangeably. So, it’s important to identify and define each entity, define how they interrelate and operate cross functionally or complement each other as well.

Cultural Competence is defined as the ability to understand, communicate with, and effectively interact with people across cultures. Cultural competence is being aware of one’s own world view, developing positive attitudes towards cultural differences, as well as gaining knowledge of different cultural practices and worldviews. (Make it our Business)

Diversity and Inclusion (D&I) separated into components are defined as follows.

Diversity refers to the traits and characteristics that make people unique.

There are six types of diversity in the workplace.

Cultural diversity: This type of diversity is related to each person’s ethnicity based on societal norms and family values.
Racial diversity: Has to do has to do with grouping based on physical traits (although not scientifically based) eg Caucasian, African, Latino, Asian.
Religious diversity.
Age diversity.
Sex/gender/sexual orientation diversity.
Disability. Functional or mental health.

Inclusion refers to the behaviors and social norms that ensure people feel welcome.

The seven pillars of inclusion are:

Access – Which explores the importance of a welcoming environment.
Attitude – Which looks at how willing people are to embrace the concepts that work towards inclusion.
Choice – Refers to identifying the options that people have Anne for them to make the choice of how they prefer to be involved.
Partnerships – This focuses on How individual and organization relationships are formed and how effective they are.
Communication – Examines the way the options that people have to get involved and to learn about culture is conveyed to them in a way they can understand.
Policy – Addresses how an organization commits to and takes responsibility for the inclusion.
Opportunities – Explorers the options that are available for people from different backgrounds particularly disadvantage backgrounds.

It’s important to understand that the two concepts can occur interdependently of each other. Usually D&I cannot correctly be accomplished without also incorporating cultural competence training. However, Cultural competence can occur and be taught or practiced alone. D&I operates more in a corporate environment and construct, cultural competence is functional in all environments. D&I is an appreciation of difference and acceptance in order to function and work in a coherent cohesive environment. It is usual a necessity for an operation to take place efficiently. It may not be voluntary.

Cultural competence requires a voluntary desire for assimilation and requires a personal commitment to learn about another and their environment. It also implies an interest in improving our selves through self-awareness and our ability to learn, enhance and build on our existing framework.

To achieve the most success in a work environment, both cultural competence and diversity and inclusion must be accomplished.

To achieve success in communities, travelling and globally, one must seek to become more culturally competent.

To create a more successful world, we must achieve and accomplish both voluntarily.

AN INTERVIEW WITH SONIA WYNTER ON FREQUENT TRAVEL AND IMPACT ON RELATIONSHIPS.

Shaw Medical Travel Consultants (SMTC) caught up with licensed clinical psychologist Sonia Wynter (SW) to have a conversation about the impact of frequent traveling on interpersonal relations and relationships. This is a two-part series with the first part written below and the complete interview available on our YouTube channel.

SMTC: How impactful do you view the effects of Travel (personal or business) on the growth of healthy relationships.

SW: There are several variables that can influence the impact of travel on the growth of healthy relationships a few of which are:

The frequency of travel and the average duration of individual trips.
The level of commitment to the relationship of each individual; committed versus casual, married, common-law, long-term or recently met.
Whether or not the couple has children.
The personalities of each partner.

SMTC: That’s interesting, how would all this impact? Would these act independently or compounding?

SW: Taking all these into consideration however, by and large, it is considerably easier for relationships to thrive when people are physically together – to state the obvious. Human beings are social animals, it’s almost as if “we are hardwired to dislike separation”* .

SWTC: Is there any difference in the impact depending on the amount of time spent apart or together?

SW: For those relationships where travel results in the couple spending more time apart than together, the impact can be significant in that it can compromise not only the health of the relationship but the mental and physical health of each individual and any children in their family.

* Nadine Kaslow, professor and chief psychologist in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta, Ga.

SWTC: In this day and age of global commerce and travel, in your experience, what are the effects on the traveler and on the non-traveler?

SW: The emotional ramifications on the traveler can include intense feelings of guilt, disconnectedness and even anxiety for some. Unfortunately for many travelers, these feelings often remain contained for the duration of their trips and find voice on their return home with destructive results for their relationship with their partner. Added to this is the physical consequences of stress related to jetlag and fatigue if the traveler fails to develop a consistent and effective mechanism for recuperation.

SWTC: And what about the non-traveler often left behind? What are the emotions they might be experiencing?

SW: For the non-travelling partner and other members of the family, there often arises feelings of abandonment, resentment, anger and loneliness and there are times when efforts to cope with these difficult feelings result in disorders or other consequences which negatively impact the stay-at home individual’s quality of life, including of course, the quality of their relationship.

Tune in to hear the rest of this information packed conversation with Ms. Sonia Wynter to hear her answers to these and other questions and learn how to cope:

3) What are if any the long-term effects of chronic traveling on personal growth and on relationship building?

4) Are there any tips that either party in the relationship can do to maintain a health and sustainable relationship.

5) Is it healthy for parties in the relationship to take personal sojourns away?

Ms. Sonia Wynter

Founder and principal psychologist at Tea House Therapy (THT) in Kingston Jamaica, Licensed Clinical Psychologist Sonia Wynter holds a BSc. (Hons) in Computer Studies and Accounting and an MSc (Distinction) in Clinical Psychology from the University of the West Indies. Ms. Wynter pursued further training in couples and premarital counseling from the Gottman Institute in Seattle WA. Utilizing evidenced based interventions, her expertise in strengthening individuals’ ability to relate better to themselves and those they love through her unique compassionate, cutting-edge approach is highly regarded. THT is a private practice addressing the emotional and mental health challenges facing adults and couples, focusing not only on individuals but also groups in both local and international settings.

The extensive career of Ms. Wynter includes functioning as a clinical therapist at the UWI Center for HIV/AIDS Research, subsequently at the Mico Youth Counseling, Resource and Development Centre in addition to positions within the Psychiatry Department at the University Hospital of the West Indies.

Contributing to her experience dealing with personal interactions, prior to focusing in the field of psychology, for 20years Ms. Wynter worked in the financial industry. After holding roles in various departments including ITC, Financial Control, Trade Finance, and Training and Human Resources, Ms. Wynter was promoted to Resident Vice President, Human Resources at Citibank, Jamaica. She has subsequently held many corporate positions as an HR consultant to financial institutions, telecommunications corporates, manufacturing and distribution conglomerates, legal firms and private medical practices.

Ms. Wynter has authored research papers on the transmission of family values in Jamaica, the impact of child shifting on the Jamaican domestic workers and the psychological defenses embattling those affected by HIV/AIDs in Jamaica.

SLICE – How Wellness practices can benefit depression.

Wellness tourism is defined as travel for the purpose of promoting health and well-being through physical, psychological or spiritual activities. Popular perceptions of the importance of diet, fitness and healthy practices have transformed and empowered vibrant new business sectors into the wellness markets. Wellness tourism is defined by the nonprofit Global Wellness Institute (GWI) as “travel associated with the pursuit of maintaining or enhancing one’s personal well-being “. According to GWI wellness tourism is an extension of the values of the lifestyle of the traveler which is not just about the destination. The incorporation of elements of health, prevention, self-actualization, experience and mindfulness into daily lives is becoming prevalent around the world – travel with an exclusive focus on Wellness centered experiences or destinations.

The question of is there benefit of Wellness travel to psychological well-being and how much can be achieved through Wellness travel and holistic experiences.

Depression is a disease very debilitating and potentially affecting many aspects of one’s life. In 2017 the National Survey on Drug Use and Health (NSDUH) reported up to about 7.1% of the US population was diagnosed with Major depression, with a biggest bulk of that being females 7.1% than males 5.3%. The prevalence of adults with a diagnosis of major depression was predominant amongst the age group of 18 to 25 years old, representing about 13.1%. About 4.5% of adults above 18 had major depressive episodes that led to significant impairment, and up to 35% did not receive any treatment for their major depressive state. Per the World Health Organization, the reasons for not receiving treatment for their disorder are due to barriers like lack of resources, lack of trained health professionals, social stigma associated with mental disorders, and inaccurate assessment /diagnosis /misdiagnosis. About 50% of adults with depression report some degree of difficulty with work, home or social activities because of their depression symptoms and 30% reported moderate or extreme difficulty.

Per the World Health Organization, depression is a common mental disorder, globally more than 264 million people of all ages suffer from depression. The burden of depression and other mental health conditions is on the rise globally. Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. Close to 800,000 people die due to suicide every year, suicide is the 2nd leading cause of death in 15 to 29 yr olds. Even during ordinary times women physicians, resident physicians, medical students face higher rates of depression then general population. Every year an estimated 400 physicians commit suicide with women physicians facing a much higher risk than the general population.

Traditionally grief and medical training has been considered weak or unprofessional and doctors have been encouraged to keep their feelings inside and they offer news the technique of compartmentalization and avoiding thoughts or emotions including isolation and distraction. As physicians the importance of self-care is important. Well known factors associated with physician depression include lack of sleep, dealing with death, making mistakes, 24 hour responsibility, self-criticism, and difficult relationships with coworkers and patients .these factors are likely to be compounded as physicians face increased pressures from COVID-19 pandemic (Rebekah Bernard MD, Medical Economics).

Benefit of holistic wellness experiences: – achieving balance ..

Many wellness practices have as a foundational principle that balance is the secret of wellness and ridding our bodies of illness. Ayurveda believes that like increases like and that opposites balance. Balancing building, nourishing, anabolic in nature, while the other is reducing, lightening, and catabolic in nature. The stress response is unequivocally a taking away and catabolic in nature; if like increases like and opposites balance then the antidote to excess stress is to offer our systems an abundance of building up, and nourishing qualities through our diets, our lifestyle, our practices and our relationships.

Many other methods of achieving holistic Wellness and balance within our lives are practiced through yoga, Tai chi, Acupuncture, Tui Na, Cupping, herbs and other remedies and interventions.

Many of these practices benefit the treatment of major depression by working concurrently with traditional medical recommendations and possibly medications by addressing underlying conditions, removing toxins, and or directly on the depression symptoms individually.

Individual changes that you can make in your life can include the following:

…….remember SLICE

Slow down thoughts and activities, reduce your To Do List, and learn to be present.
Learn to appreciate calm, redirect energies internally, mind and body by practices such as yoga, structured breathing exercises, meditation etc.
Indulge in quality self-care which involves learning to appreciate ourselves your individuality, become aware of your needs and your desires and what makes you feel good.
1. Take a long bath.
2. Drink herbal tea.
3. Massage your feet before bed.
4. Enjoy nature.
5. Read an uplifting book.
6. Write in a journal.
7. Enjoy art – drawing, painting, writing stories, photography.
8. Balanced diet, adequate rest.
9. Supportive loving relationships.
Commit to a daily routine – our routine is particularly important when you are trying to balance the effects of excess stress. Regularity is important for balance within our physiological and mental being.
Eat a balanced diet – our routine is particularly important when you are trying to balance the effects of excess stress. Regularity is important for balance within our physiological and mental being.

Recent global stresses affecting our health, economy, personal and interpersonal relationships have caused many psychological and mental conditions to develop or worsen. So let’s not forget the benefit of and the importance of Wellness and alternative treatment nor intervention that can work concurrently with traditional medical recommendations.

SLICE

How I became disillusioned with medical mission travels.

I’ve always had an interest in helping those less fortunate than me and with my healthcare experience and exposure I thought I could meld the two to effect a positive impact. I’ve lived in a third world country and am intimately aware of economic trials of people struggling to exist. I’ve lived in developed countries and also seen marginalization of people from different ethnic, cultural, racial backgrounds struggle to exist. It is apparent that in many instances the need to struggle to exist is not solely dependent on where you come from or your country of origin. Within countries of those who struggle there is often clear economic inequality as living very close to these struggling people are others of wealth and means.

I chose to get involved in medical missions and volunteer my services locally and abroad.

I thought being involved in large organizations would allow me to experience life through other people’s experiences and share my knowledge to enhance someone else’s life.

I soon realized much of what I thought would or should occur in fact does not.

In getting involved and traveling to various countries I soon realized that the needs and objectives of those organizing some of these trips were influenced and focused more on desires to meet and check the boxes of perceived social obligations in order to satisfy some organizational economic or financial need.

There was a lack of understanding and appreciation of the communities and the cultures in which volunteers served, there was a lack of attempt to assimilate with the cultures. Many individuals in these communities, countries or cultures were viewed as exotic or interesting and so pictures were taken as a photo opportunity.

Of course services were provided whether it was in health care or construction or whatever else but there was limited concern as to whether these met the need of the community or what would occur once the volunteers boarded a plane and left the country. Did the medical building that was established utilize the human resources within the country or did the volunteers build it all themselves? Was land used that could have been used for farming or cultivating? There are so many questions most never considered.

Whatever became of the person with whom you took a picture that now is prominently displayed on your social media or other platforms indicating your altruistic attempts at giving back? Did I offer some assistance, or provide for the ‘model(s)’ in the pictures? Did I have a conversation with them or ask them how life is in their world? Did I ask them if they go to school? How far is school away? Did I ask them how they make a living? Did I enrich their lives and make a difference for the long term? Did you really care or was it the opportunity for a photo up because of your need to stand out amongst your social circle at home for ‘likes’? Wouldn’t it be better to take pictures of ‘doing’ and interacting and not just for photo opportunities?

So, I became disillusioned and decided this was not the means by which I could volunteer and offer my services to the best of my ability. So, I began the search for more meaningful ways to share, enhance and collaborate within communities, with other cultures and with other people. It is important that not only do I enlighten myself and enjoy the experience but more importantly it is through meaningful selfless interaction, appreciation, understanding and giving that mutual benefit can realistically be achieved.

I am reminded of a quote by Anne Frank, “No one ever became poor by giving” and Albert Einstein’s comment “It is every man’s obligation to put back into the world at least the equivalent of what he takes out of it”.

So, from being disillusioned I am now enlightened and excited to be able to impact people’s lives in meaningful ways for them and in a way that will be sustainable after I have left their location.

From what I have learned, I implore others in the search for volunteer opportunities to ensure that you are giving more than you take.

HOW CULTURE AFFECTS HEALTH AND WELLNESS.

Culture affects health and healthcare in many ways and realizing this will impact success in disease management and achieving Wellness as well as interactions during mission and charity ventures.

“Health is intertwined with the fabric of life and the beliefs and practices that go with it, health and culture exist and interact within a broader social, political, an economic environment “

The classical definition of culture is “the complex whole which includes knowledge, belief, art, morals, customs, and any other capabilities inhabits acquired by man as a member of society” – EB Taylor 1871

No culture is ironclad or fixed, cultures always change, adapt, and evolve over time. It is fluid, more like a central tendency of which there may be variations.

Culture is not fixed but evolves – as people from one society or group come into contact with other people, or as they change overtime, their cultures change.

Being healthy is viewed differently depending on the culture. Being ‘Healthy’can mean the absence of disease such as in United States of America, it can mean representing a balance of mental, physical, emotional, and spiritual components such as in north American Indians. Being healthy can mean harmony of relations and interdependence on other people eg Buddhist .and in some cultures being healthy is synonymous with a large body size which can indicate high social status such as in some African countries for example Senegal.

Encyclopedia of Herbal Medicine: 550 Herbs and Remedies for Common Ailments

It’s imperative to understand the political environment, economic environment an historical environment of the region of origin of an individual (eg, American Indians or African -Americans) to fully comprehend their view of health and Wellness and how to help them impact their health and utilize healthcare resources appropriately. Poverty and social marginalization or inequity and inequality in social economic status, or countries torn apart by war – Religious war or civil war ( eg. Muslim/Islamic) can impact health and wellness.

Family and community involvement impact healthcare decision making for many people and patients. It is important to understand that some cultures prefer if not require family members to accompany the patient during the health care visit. Muslim /Islam, Hindu may require a male figure to accompany the patient, other cultures such as Latin American cultures and American Indian are very family oriented, and a successful health care encounter and follow through will not occur if family is excluded.

Religious practices & beliefs impact access to health and the perception of health. In Latin countries there are various practices such as Catholicism, Santeria, Espiritism which provide advice and counsel and serve as an adjunct to medical care. In Asian cultures there are multiple different types of religious or belief systems that can impact access to care and health. Beliefs such as Buddhism, Taoism, and Confucianism and Shinto provide guidance and can interfere with how authoritarian figures are viewed and how the transfer from life to death is viewed. Muslim /Islamic faith believe that they are spiritual beings having a human experience contrary to Christians who believe they are human beings searching for a spiritual experience. Cleanliness governs Muslim life, and this must be kept in mind with a hospitalized patient for example the need for showers as opposed to bed baths and the need to wash themselves instead of using toilet paper. Other beliefs such as Yin and Yang in Chinese culture which emphasizes the need for balance in all aspects of one’s life to avoid disease. Witchcraft and sorcery also are used in some African and Caribbean countries and are seen in certain cultures as the source of HIV infection which can interfere with appropriate treatment an intervention.

Chinese Herbal Medicine for Beginners: Over 100 Remedies for Wellness and Balance

Culture healing methods which may be used alongside Western medicine treatments such as herbal medicines and remedies. Ceremonies and certain dietary restrictions or specific inclusions depending on the experience also affect the way health and wellness are viewed.

So, understanding how all the above impacts the way a provider interacts with another person such as a patient or how a health care provider in a charity or mission clinic interacts with those they are attending to will improve you, the provider’s, ability to meet the needs of your patient. It’s important to be aware of these differences and to engage in conversation marked more by listening and observing then speaking initially. Also being aware of some of these alternative methods of staying healthy in some cultures will help direct your line of questioning and will provide you with knowledge of questions to ask to ensure that a full understanding of the health care needs is met.

WHAT TO EXPECT WHILE TRAVELING IN THE POST COVID-19 ERA.

“It is only after one is in trouble that one realizes how little sympathy and kindness there is in the world” – Nellie Bly

As the travelling community gears up in the next many months to resume essential and non-essential travel when borders are reopened, we can expect many changes. We can protest but there will be changes that we will be forced to accept and adapt. What are the expected changes?

Starting with the person in the mirror – you.
1. Due to being isolated and experiencing solitude, you might have realized new talents and acquired new hobbies and possibly new skills.
2. Your perspective on life may have changed, your focus maybe more on self-actualization and less on work or career goals.
3. Your career goals may have shifted, acquired a new timeline, or completely changed altogether.
4. Do you have a new sense of purpose, possibly you might have realized your life was like a revolving door and possibly leading nowhere?
5. Maybe you realize this time to actually take a break in life, and take time to reflect and re direct your focus.
6. Perhaps over the Internet you made new friends and acquaintances whom you’d like to get to know better.
7. Realize that if you are feeling depressed, travel during this time might actually add to your stress level and not be a good idea.
Realize other people have changed.
1. Being isolated from friends and family for months, it’s possible they went through the same changes you have and uh now have a completely different focus- possibly your lives have become divergent.
2. Realize family members may not appreciate your newfound self-value and your newfound purpose.
3. Realize that when you start to travel people in other countries have likewise changed.
Realize that countries may have changed.
1. Reopening borders after having closed for an extended period of time now requires stringent rules and different laws and New habits related to social distancing.
  1. There are some cultures such as the Asian cultures which practice habits more adherent to social distancing than cultures in the Western Hemisphere which tend to be more apt to embrace, handshake and polite kisses on the cheek.
2. Many countries maybe struggling economically and thus there may be more poverty and begging, more homeless and more destitution.
3. As many countries may be struggling, there may be two extremes in behaviors seen:
  1. You might see the extreme need to please in the tourism industry because of your capital investment in their industry.
  2. Alternatively, you might see a state of apathy and resentment towards your ability to spend money and resources compared to their lack of ability.
4. Due to the economic challenges, there may be a shift in how some countries spend their resources, certain amenities and luxuries may be curtailed in lieu of essentials needed to operating function.
5. Understand that many tourist and other industries having significant financial challenges may only open and operate on a limited capability.
6. Understand that those working in these industries which are financially challenged are also financially challenged and highly stressed, thus a kinder attitude embraced in a high degree of tolerance on your part will be necessary.
7. It’s also important to appreciate that during such struggles, cultures may tend to embrace their togetherness and empower their unique harmony, to the exclusion of foreigners or other nationalities and cultures – it’s important to appreciate this and not take offense.
8. It will be important to realize that usual places of for hire during travel time such as hostel, and Airbnb homes may either be unavailable due to social distancing restrictions or maybe more expensive due to new requirements for maintaining stricter hygienic regulations.
9. Also, it’s important to realize the need for social distancing and hygiene requirements while travel, eating out casually or informally eating on the streets or buying art and crafts.
The travel industry including trains, planes, and other public means of transportation.
1. Although this is addressed in more detail on other platforms, it is important to realize how transportation will change as it relates to availability, capacity and price.
2. Be aware that travel insurance might either exclude any diagnosis of COVID-19 or related symptoms doing this restricted travel time and some companies may not offer insurance at all.
3. Understand that you might need to bring your own personal protective equipment (PPE) and not rely on the countries or tourist industries to provide this for you.
4. Be aware that on these modes of transportation, social distancing may not be appropriately enforced but with PPE you can still attempt to follow the regulations in place at the time of your travel.

What’s important to realize that in this new era of post COVID-19 travel, we have to engender kindness, mindfulness, tolerance and appreciation of our differences now more than ever before. Everybody is going through similar challenges and trials just at different times, different levels and with different abilities to overcome.

As Mark Twain said, “Kindness is a language which the deaf can hear and the blind can see”

How to pick a country for medical mission work.

Medical missions are being organized all over the world originating generally from countries in the West and organized through church or religious establishments and /or civic groups such as Rotary, Kiwanis, Links etc. These are all well intentioned ventures with a mind for doing good and with intentions of filling a deficit in certain countries of what they perceive to be needed resources, opportunities, or services. Here are some tips that may help you to improve and enhance your experience while providing the most benefit and return an engagement from your efforts.

First start with yourself.
1. Ask yourself why you want to go on a mission trip.
  1. Maybe you need a break from your everyday life and stresses.
  2. Maybe you’re trying to change the focus of your life and trying to understand more about yourself.
  3. Maybe you want to learn more about different country and culture.
  4. Maybe this is an opportunity for personal growth and introspection.
  5. Maybe you’re trying to find purpose in your life.
2. What is it you want to get out of the mission trip?
  1. Do you need credits for an activity?
  2. Are you a part of a church group or other civic organization and this is one of the annual opportunities available?
Next look at the mission venture.
1. What group are you going with, who is organizing the trip.
  1. Do you know those who are organizing the group?.
  2. Do you know the history of the group and how it began?
  3. Are those organizing their trip in the group the original members, and if not is their philosophy similar to that of the original creators of the group.
  4. Is it group close to you or is it at a distance?
  5. Is there a financial obligation or a financial incentive?
  6. What is the money trail?
2. Why did you choose this group?
  1. Was the group recommended to you?
  2. Did you find the group on Google search?
  3. Is this a school, church, club venture?
3. What is the purpose that is driving this mission venture?
  1. Has your organization discussed this with you and the team?
  2. Do you get a sense that there’s unification of purpose?
  3. Is there a vision and mission of the group that’s clearly evident?
  4. Has the group done this frequently visiting other countries and what is the experience and outcome of those ventures or adventures?
  5. A Drop in the Bucket: The Joys, Sorrows, and Horrors of Medical Missions
What countries are being chosen.
1. Why are these countries being chosen and how are they selected?
2. What is the criteria for being selected and how do they compare one country with another as to eligibility for being selected?
3. Is there a connection between the organizers and the country?
  1. Maybe there is a working relationship possibly or a religious connection, there could even be a familiar connection currently or dating back to the origins of your group and organization.
  2. With this connection is there some partiality amongst members of the group, is there any withheld information from different members of the group.
4. Look at the climate of the country and the usual weather and expectation for climate catastrophes such as hurricanes or monsoons.
5. Investigate the terrain and environment.
  1. Will there be a lot of uphill travel possibly travel that vehicles cannot navigate, Will there be a lot of walking involved.
  2. Are special types of clothes and shoes going to be necessary.
  3. Is the environment going to be very wet forestry or dry and desert like, or possibly hot and humid Anne what protective gear or precautions need to be considered?
6. What about the safety of the destination?
  1. Have you discussed this in detail and inquired about what limitations and restrictions you will have in the venue and outside the venue?
  2. Is it safe to venture outside of the venue? and if so, can you do so alone, or should you have accompaniment?
  3. How are the sleeping and boarding arrangements planned amongst the team?
What about communication & connectivity?
1. What is the level of communication availability in the country?
2. Is there a limit to the availability of the communication? Are there specific hours or locations with more connectivity, specific times of the day or specific days where and when this communication will be available?
Do you have to be aware of any geopolitical concerns?
1. What is the political arena of the country and countries around it at this time?
2. Is there any mutiny or civil unrest that you need to be aware of?
3. Is there any negative sentiments currently between your country and the destination country that you need to be aware of?
  1. If present, is this a good time for you to travel? possibly an alternative time would be better if not a different country altogether?
4. Look at the climate of the country and the usual weather and expectation for climate catastrophes such as hurricanes or monsoons.
5. Investigate the terrain and environment.
  1. Will there be a lot of uphill travel possibly travel that vehicles cannot navigate, Will there be a lot of walking involved.
  2. Are special types of clothes and shoes going to be necessary.
  3. Is the environment going to be very wet forestry or dry and desert like, or possibly hot and humid Anne what protective gear or precautions need to be considered?
6. Are there any particular do’s and don’ts, faux pas that you need to be aware of in the country as it relates to the political arena.
7. THERE IS A HEALER: Stories of Medical Missions Outreach
What are the language barriers?
1. Will there be sufficient translators or do the people in the region understand your language?
2. Is it best to go to a destination that you’re familiar with the language?
What about food and other necessary amenities?
1. Do you have specific dietary needs, and will this destination be able to meet those needs? Are there substitutes available?
2. Is the native food consistent with your dietary requirements and or needs?
3. How about your medications, what if you run out – is there a pharmacy and or medical facility within reasonable distance?

What’s important here is that you find the mission program that is in line with your purpose, your vision and mission in life. It’s important that the venture serves to add value to your life and by so doing you add value to the program and to those whose lives you touch. You want the experience to be mutually beneficial and one that will help the country you visit and the people you visit to be better off because you were there. Essentially you want to give more than you take but in the long run when you look at it this way you, will be better off.

shawmedco.org/medical-and-community-missions/

Tips for choosing a physician or surgeon.

HOW TO FIND THE RIGHT SPECIALIST.

In this blog we will talk about the tools you need to select the right physician for you. We’ll start with general questions, inquiries and background information you should check on and know about all your physicians and then subsequently fine-tune some details related to certain specialties.

First for the general information:

Verify the physician’s credentials and that they are active, Do a Google and social media search including LinkedIn.
Verify that the credentials are universally active, in other words a physician may be working in a different country.
Verify that the credentials are universally active, in other words a physician may be working in a different country having had his license revoked in a different country or state.
Understand that sometimes physicians may have tainted license, malpractice suits in the past but this does not necessarily indicate that they are not good physicians, so it’s important to learn the details.
Find out who will be cross covering for the physician in his or her absence and the details of this position and their capacity.
Find out if there are physician extenders such as nurse practitioners or physician assistants that are working alongside the physician and whom you may see. It’s important to understand how often you will be interacting with this person as opposed to the physician.
Inquire what the process is to reach the physician specifically as opposed to a physician extender. At this time make it very clear if you are uncomfortable with seeing a physician extender and request only to see the physician – as you are paying for his for her services, they should comply with your wishes.
What is the process for caring for you if you have chronic medical conditions and you need medication management – who is going to do this and when will you be meeting this person before your procedure.
Ask your physician how many of the requested procedures has he or she performed over what period of time and inquire about the success rate.
Ask for references – Ask if you could speak with a former patient if you’re interested – if the physician refuses this should be a red flag.(note that privacy laws apply and the former patient will have to have previously authorized this).
Investigate the location (hospital or outpatient facility) where procedures and surgeries will be performed. It’s important to make sure these facilities are adequately credentialed which would indicate they comply with quality expectations amongst other requirements.
Ask about his or her position on pain medication prescribing and refill process.
Ask if the physician will provide follow-up documentation to your primary physician if you want or will they provide you with a copy of your records.

RED FLAGS

There are some red flags to know about when interviewing a physician for your procedure that you need to be aware of and alter your plans accordingly – meaning you may choose to continue with the physician or change.

The physician is not open to any of your questions and refers you to hey website or printed documentation. although this is helpful it is important to have the comfort of being able to speak with your physician and this indicates the amount of time and investment the physician places in the value of a patient physician relationship.
There are multiple malpractice lawsuits resulting in culpability of the physician.
The physician previously had license revoked in other places – countries or states.
The physician has not maintained continuing medical education or current certification.
The physician and or staff is not willing to review billing practices.
There is no internal medicine physician who will take care of your chronic medical conditions if any medical non-surgical complications should arise.
The physician refuses to provide information on 6 of past successful and unsuccessful cases.
The physician refuses to provide references or authorize you too speak with other former patience (assuming there is a patient privacy document in place, signed and authorized).
There are no provisions for coverage when the physician is unavailable eg. on vacation.
There are no subspecialty physicians on staff at the facility where the procedure or care will be provided in the event of complications, these physicians include a lung doctor (pulmonologist),heart doctor (cardiologist), or other specialties as necessary.
The facility/hospital where procedures are performed has not met the quality standards in the country requesting. understanding that countries outside of the United States may not qualify for the same quality certifications but there is an equivalent certification that they have indicating they have met quality expectations. (the equivalent to NCQA, JCAHO, JCI, TEMOS for example). It is OK to make decisions based on how a hospital or facility looks to you – use your gut feeling.
They refuse to share the infection rate, or they have an unusually high infection rate at the hospital.
The position does not allow for provision of pain medication. note that this is a very controversial and sticky area in health care currently, so most practices will have a very stringent, strictly regulated policy for pain medication prescription and refills which you will be required to review and sign or accept – this is OK. However, the physician office stating that they will not prescribe, or refill pain medications is not OK, as these medications may be necessary.
There is no post-operative process or procedure in place.
Make sure that you understand the pre, intra and post-surgical treatment which may include blood thinners, are there devices to prevent blood clots, therapy – physical or occupational depending on needs.

PLASTIC SURGEON

Best to try to find a physician with a good bedside manner and patient rapport – bodes well if complications should arise later.
The physician and staff should provide customized tailored treatment options and spend time designing you are specific treatment. all your questions should be answered and whatever time it takes to make changes should be provided.
An established physician should have a good electronic medical record system which helps to design your personal treatment program to give you a good image of what you’re expected to see, this is better than a written documents or drawing.
https://www.facs.org/education/resources/residency-search/specialties/plastic
https://www.americanboardcosmeticsurgery.org/patient-resources/cosmetic-surgery-vs-plastic-surgery

CARDIOVASCULAR (HEART) SURGEON

There is a cardiologist who works alongside the cardiovascular surgeon and they communicate with you to your liking giving you enough time for discussion and questions.
There are qualified technicians to provide related services such as echocardiogram, ultrasound, nuclear stress test, regular Bruce protocol stress test.
Ensure what expectations should be regarding physical activity after the procedure.
What adequate patient information will be provided for you to read and are diagrams provided regarding the anatomy of your heart or vessels and what operation is needed.
Adequate preoperative evaluation and postoperative course has been explained to you thoroughly as well as which medicine is to continue and or stop.
Is a cardiac rehabilitation program recommended and if so, can they refer one? If one is not readily available, can you be instructed on exercises to do or is there a video provided for this purpose?
https://vascular.org/patient-resources/what-vascular-surgeon

ORTHOPEDIC (Bone) SURGEON

Ensure that you like the bedside manner of your physician and staff.
Ask questions related to the duration of surgery expected (understand that it is impossible to anticipate exactly). The type of anesthesia to be used and request to meet with the anesthesiologist prior. Find out whether a nurse anesthetist or an anesthesiologist (a physician) Will be attending your case.
Find out whether antibiotics will be given before the procedure.
Inquire about the post-operative management, specifically related to therapy required and duration.
Inquire about expected outcomes, expected recovery time and level of function expected after surgery and therapy and also any potential limitations after surgery.
https://www7.aaos.org/member/directory/definition.htm

Solo Female Travelers Shouldn’t Have to Choose Between Being Adventurous and Being Afraid

Article source: By TYLER WETHERALL at https://www.cntraveler.com/

I THOUGHT BEING A FEARLESS FEMALE TRAVELER MEANT I COULDN’T SHOW FEAR.

After I returned from Cuba, friends asked me how it was. Amazing, I said, and I meant it. I told them about the tumbledown houses and rattle of old cars. About dancing on the streets of Baracoa or hitching a ride on the back of an ox cart through the jungle. I also told them I found it hard to travel there as a single woman. And then I told them a story about what happened to me in a cab in Havana.

I have always defined myself as an adventurous female traveler. I first went backpacking at 17 years old around Central America, and I’ve since traveled to nearly 50 countries, often alone. Men have harassed me on the street and followed me home. A hotel owner in Guatemala once let himself into my room at night. I know I am lucky that nothing worse has happened. But the experience in Havana shook me, because I didn’t know how to bridge the gap between being an adventurous—read, fearless—female traveler and being afraid.

I had been in Cuba for over a month. I knew how to navigate the streets of the capital without a map and shout back good-humoredly in Spanish at the men who heckled me. After clubbing with some Cuban friends, I hailed a taxi around 2 a.m. I sat in the front because I get motion sickness and I like to practice Spanish. The taxi driver and I were chatting about life in Cuba, when he told me I was beautiful, and I felt the familiar clench of fear in my gut. I looked out the window. He asked if I wanted to see something, and I already knew he was holding his penis. My first response was to laugh, and then I told him to stop the car. But he didn’t. He started grabbing between my legs with one hand, while masturbating with the other, all—remarkably—without crashing.

I DIDN’T KNOW HOW TO BRIDGE THE GAP BETWEEN BEING AN ADVENTUROUS—READ, FEARLESS—FEMALE TRAVELER AND BEING AFRAID.

When I told my friends this story, I told it like any other travel anecdote, emphasizing the humor in the uncomfortable situations we find ourselves in while on the road. I wanted people to laugh with me, because that would normalize it. I didn’t describe it as sexual assault. If I called it assault, I would have to confront its impact on me.

Instead, I described how the car had no door handles on the inside—common among the tin can cabs of Cuba—so I had to manually open the window, painstakingly slowly, to reach through and open the door from the outside, staving off the taxi driver’s gropes at the same time. I didn’t feel in real danger until the taxi stopped, and suddenly we were on an empty street. He stood on one side of the car, and I, on the other, ready to run. Then he asked me for the $3 fare. I was dumbfounded, but I handed over $5 and waited for my change, because there’s no way I was giving this guy a tip. See how it’s almost funny?

There has been a well-documented rise in female solo travel over the past few years, and I celebrate it. But there is another older story that when women choose to travel alone, they’re placing themselves in danger. Gender violence happens everywhere, but the conversation changes once the experience takes places abroad. When I told people what happened in Cuba, they responded first with alarm, and then with criticism. I should not have been out at night alone. I should not have sat in the front seat.

A recent New York Times article, “Adventurous. Alone. Attacked.,” itemized violence against women traveling abroad over the past four years, including the horrifying killing of Carla Stefaniak by the security guard of her AirBnb in Costa Rica. It is an important piece of journalism, but reading it made me feel uncomfortable, because it perpetuated a narrative that solo travel is too dangerous for women, a narrative I’ve resisted throughout my career. But neither can I deny the reality of traveling alone as a woman. So where is the middle ground?

TRAVEL, LIKE MUCH OF THE REST OF THE WORLD, HAS ALWAYS BEEN DEFINED THROUGH A MALE LENS THAT VALUES BOLDNESS.

We tell stories in order to make sense of the world. I talked about what happened in Cuba because I was trying to make sense of it within my idea of what it means to be a traveler. I grew up on stories of adventure. As a kid, I read Bruce Chatwin, Bill Bryson, and Jack Kerouac. I remember the thrill of discovering Mary Wollstencraft’s 18th-century travel memoir, Letters Written in Sweden, Norway, and Denmark. I reveled in her bravery to set off virtually alone (with just her maid and her infant daughter) at a time when it was near unthinkable for a woman to travel without the protection of a man.

I continue to seek out stories of female adventurers, but travel, like much of the rest of the world, has always been defined through a male lens that values boldness. I want to be brave, too. I often hear a voice in my head that says if a man can do it, dammit, so will I. I have hitchhiked at night with defiance, slept outside in a hammock in bandit-infested jungle, and knocked on the doors of private homes looking for a room to sleep when I found myself in a remote coastal village with no hostel. In order to claim the title of adventurer as my own, I have felt obliged to follow in men’s “fearless” footsteps. Perhaps that is why I struggle to make sense of experiences such as what happened to me in Cuba; it is not represented in those stories of adventure.

Media offers us two versions of solo female travel: the inspirational story as it exists on the pages of Eat, Pray, Love; or the story of women like Carla Stefaniak. As long as society’s view of female solo travel is informed by these two narratives, stories like mine, and so many others, don’t have a place in the travel world. And if that’s the case, we need to rewrite the script to recognize that these experiences might happen, but they should not hinder our right to roam the world alone. We need to create our own travel narratives, one in which we might not always be fearless, but we can certainly still be brave.

Q.- Who is the blame when ppl are ill because of socially created vulnerabilities? Is it the individual? Is it an external source ? Or is it the social & political arrangements themselves & those who benefit from them?

You are invited to answer those questions in our comments section.

Medical Missions – not a “one and done” initiative.

Part I

Search the Internet and you will find numerous churches, civic organizations, Charity organizations and schools offering medical mission trips to locations in South America, Central America, Caribbean and Africa to name a few. Many of these organizations are reputable in and of themselves. Some mission trips are surgical in purpose serving a dire need of repairing physical malformations, others serve to provide medical services cognitive and procedural, others serve to build structures. Much funds are often raised to support these ventures and although financials can be requested this is rarely done. There have been many reports of money not spent judiciously or cost effectively, funds not spent for services but to address a more burdensome administrative overhead and possibly even salaries.

Of fundamental importance is the need to have a collaborative arrangement with those the mission is intended to help, specifically the mission must be designed to help the local community in ways that they wish to be assisted and they must be a part of the mission. It’s important to be educated and understand the importance of cultural competence and cultural awareness as well as to be cognizant of the importance of the political arena, geographic position, religious and anthropologic history behind the culture and people of the mission.

As with any population health management project or collaborative effort, the following considerations must always be included during reviewer validity of a program. Consideration must be made for economic stability, neighborhood and physical environment, educational level, food/hunger, community and social context and the established health care system if any.

Specifically when considering economic stability one must investigate opportunities for employment, income and any other expenses; when considering neighborhood and physical environment consideration must be made for housing, transportation, safety, playground and parks and walkability; when considering education, literacy and language , vocational training or higher education must be considered; when considering food one must look into hunger and access to healthy options; for community and social context the consideration of support systems, community engagement, discrimination and social integration are important and lastly the health care system that is in place and the coverage, provider availability and access, quality of care and also linguistic and cultural competency of the providers in the system.

The strategy to accomplish a successful structure, organization and management of a medical mission whether volunteering or creating should ensure that these tenets serve as the filter through which a program is built. It is imperative to appreciate that the constructs have a medical mission should be self-sustainable. This means that the local citizens of the region should be educated and taught how to incorporate the new information and or experiences or resources provided to enhance their current existence in a manner desirable to them and sustainable by them. However, the visitors overseeing the medical mission or volunteering within the medical mission should also include as part of their sustainability strategy a plan to return periodically to the mission location to provide continued services or resources as needed.

Subscribe to our blog to receive Part II & Part III with tips on structuring your medical mission.

How to interview your doctor when traveling for medical care – 21 must ask questions.

Have you ever been to a doctor to consult on your medical conditions and been very uncomfortable or got the impression that they didn’t know you or didn’t understand you or there was just a lack of communication? Have you ever gotten nervous traveling outside of the country and felt like you did not know how to make sure you were asking the correct questions or investigating the right things?

Below we listed a few questions you might find helpful to answer all these and more questions to Help you feel comfortable and secure about your choices.

How long have you been practicing?
How many of these procedures have you done?
What hospital do you use and is your hospital accredited by Joint Commission international or a similar body?
Are you board certified by the American Board of Medical Specialties, or a member in good standing from any one of the following colleges: Royal New Zealand College of Practitioners, Royal College of Great Britain, College of Physicians of Canada, The Royal Australian College of Physicians or similar entity?
Where did you do your medical school and residency or advanced specialty training and when?
Can you share your data on successfully completed procedures and mortality data?
When investigating or searching the Internet will there be any negative publicity or concerning findings?
How is aftercare arranged – especially if I am not able to communicate due to anesthesia?
Will there be a translator proficient in medical jargon available to help with communication?
Will I be provided with a preliminary visit to explain the detail of the procedure and allow question and answers?
Will I be greeted at the airport and be provided transportation to visit with you and your staff as well as to the convalescing location post operatively?
Can I take a tour of your operating facility, the hospital that you use and your office?
What about amenities and conveniences? – is there a concern for electrical outage or recurrent computer malfunctions? Do you have a generator to mitigate electrical outages?
How are emergencies handled? how reliable, efficient and timely is the ambulance first responder system?
Will all my bills be consolidated or am I to expect bills from multiple entities?
Are the bills itemized or bundled in ways difficult to understand?
With my program all expenses have been paid so there should be no reason for other expenses to be accounted for, is this correct?
I have other medical conditions, who is going to consult on my case to help manage these conditions to prevent complications?
If I need to speak with someone after the procedure, how difficult will that be and who will I be speaking with – the doctor or nurse or another person?
Do you carry malpractice insurance and what is the coverage?
In my culture there are some limitations to male and female interaction even if between a physician and patient, will you respect my wishes when conveyed to you and are you able to accommodate?

Avoid mistakes, Let us help you find that perfect doctor!

Click here for more information

How to compare the quality of facilities and physicians.

It’s important you understand how to tell how good one facility is when compared to another or how good a physician is compared to another. There are many different measures currently available throughout the globe that compare medical services and health care facilities. As a layperson it may be difficult with the hodgepodge of confusing alphabet soup organizations that deliver comparative metrics to distinguish the significance of an evaluation or a grade given by these entities. So, what are some of the easily understandable and reliable ways to compare physicians and institutions across cultures and countries from a safety and quality standpoint.

The Joint Commission International (JCI) Accreditation Standards for Hospitals manual describes JCIs approach to improving quality and patient safety concerns and thereby reducing the risk to patients and to staff. The JCI Standards define the performance expectations, structures comma and functions that must be in place for a hospital to be accredited by the JCI. Although the JCI is recognized as the global gold sealed of approval, there are many other organizations that offer quality certification. JCI is responsible for accreditation of academic medical centers, ambulatory care facilities, medical transportation organizations and primary care centers. The JCI clinical care program certification (CCPC) Talking about we don’t care provides protocols for quality patient care in specific areas of expertise (Such as heart related diseases eg. acute heart attack, kidney disease , heart failure, HIV , diabetes , cancer all types etc ). Other organizations such as the LeapFrog Group, World Health Organization, The National Association of Healthcare Quality (NAHQ) and on an international front – Temos International and others.

Health care quality indices used to rank countries include The Commonwealth fund, Legatum Institute Prosperity Index, The Health care Access & Quality (HAQ) Index.

What is a benefit of accreditation to a patient?

Generally, a facility with accreditation provides a level of confidence to the patient that the facility or other health care environment has met strict criteria in patient safety, delivery of clinical care, overall patient support and more. We will give you some tips used to measure quality by JCI and other organizations to compare in these areas:

Patient centered care/ Patient-Centric.

Patient safety.

What is done ie what processes and procedures are in place to prevent harm and to prevent complications as a result of your procedure or surgery.
What checklists are used doing surgery anesthesia, and do the nurses have a process to notify physicians of a changing condition, complaints or side effects.
What is the process for double checking accuracy of medications and blood or fluid transfusions.
Are you given a name bracelet and is that bracelet tracked every time a new personnel or clinician approaches you or when blood is drawn or medications and tests are given or done?

Patient satisfaction.

You usually get a patient survey to complete and this will include things like how do you like the food , the nursing staff and other staff attitude towards you , how comfortable you were in the hospital /facility , how easy it was to get around.

Communication, documentation and ability to contact.

Does the staff explain your care, potential side effects, expected outcomes, and what the plan is after the treatment or procedure?
Who will be covering in the original physicians absence.

Care follow up.

What is the physician and the hospitals’ plan to take care of you after the procedure or tests.
Is this plan written out in a language that you can understand?
Is there follow up with your physician at home?
Is there an integrated plan meaning a nurse, social worker, dietitian, wound care specialists etc?

Health care organization management.

Facility quality, quality-of-care and processes.

What is the facilities’ Process during the admission process, billing process, claim submission, collections- Fees paid upfront or a payment agreement.

Physician training, quality.

What is the training of the physician and team , their credentials -are they board certified and from where is the board certification (not all are legitimate).
How many procedures have they done and what are the outcomes of the procedures.
Who will be assisting your doctor with the procedures and what are the qualifications of these people/conditions.

Timeliness.

Do you get test results and follow up recommendations back timely within a few days?
Do the clinical staff respond to your inquiries and calls within a reasonable amount of time or do you have to place multiple calls to get a response, how rapidly are you seen/is care delivered eg in the ED/ER?

Effectiveness.

This measure indicates that the physician and practices adhere to best-practice care guidelines and achieve expected outcomes when compared to his or their peers.

Transparency.

Is there willingness to share information and share data with other physicians, other facilities and with you?

Integrated care.

Integrated Care – Is there collaboration and a team approach to the care or is the position of one (wo)man show and not willing to consider other options or suggestions?

Interoperability.

Is their computer system able to talk /communicate with other computer systems such as your physician and hospital or all the positions in your care for example?

Efficient use of medical imaging.

Is there an excess amount of xray & related test being done eg. chest X Rays done every day while in hospital?

Mortality.

What is the outcome of the surgeries and other procedures that are done? – these are questions that need to be asked up front and hopefully there is written documentation to support any claims. There is usually comparisons with like specialties and among peers that are publicly available

Should I quit my job and travel? What do I need to think about?

Many dream of traveling at will, traveling without need to worry, but worry if it’s the right decision? When is the best time? How will you finance it and a host of other valid concerns.

There are a lot of stories on the web recounting personal experiences, pros and cons from anecdotal experiences but none that carefully detail all that needs to be considered. So here we will give you some pointers, pros and cons for you to consider before making this life changing move.

Take time alone to think.
1. Think about where you are in life now.
2. Do you know where you want to be in the future?
3. Are you aware of your happiness factor?
4. Do you feel fulfilled in your life?
5. What are your goals.
Consider your reason for wanting to travel.
1. Are you trying to keep up with the Joneses, your friends maybe?
2. Do you want to get away from something – family or relationship turmoil, changing mood such as depression?
3. Is there a do-good outcome possible?
4. Is this for religious reasons?
Your job.
1. Are you stagnant, not challenged, not fulfilled?
2. Is it the wrong job for you – do you know the right job, what you want to do?
3. Are you earning a good salary?
4. Weigh the pros and cons of a sabbatical, leave of absence vs quitting.
5. Have a conversation with your boss and superiors as to your options.
Do you have enough money?

Do you have any savings, rainy day account? 401K, HSA or IRA?
Establish an emergency fund – regardless of your income, could be 5%, 10% or 20% of your income.
Establish a budget and solicit help if you are unsure of how to do this GoGirl Budget Planner
Be realistic and minimalistic with regards to estimated expenses while traveling.
Look into lodging ahead of time and make temporary plans.
Have an idea of exchange rate and the strength of your money.
Look up volunteer opportunities as you may be able to get free lodging.
Apply for 2 or 3 credit cards, but make sure you have the provisions to pay the balance.
Try to plan and save money at least a year ahead of your travels.

Reconsider your current living expenses.

Do you own your home?

You could sell your home and add the proceeds to your savings.
You could rent your home out and live with family or possibly rent a smaller place to live.

Are you currently renting??

Consider moving into a smaller unit.
Consider moving in with the family.
Consider getting a roommate to cut the expense.

Do you need to get a second job or a side gig to help save more money?
Consider selling your furniture and other items that may not have sentimental feelings attached.
Reassess your needs vs wants and try a minimalist lifestyle if able.

Networking and Name Association – If your career is set.

Consider trying to secure a job with your current employer upon returning.
Network extensively among peers and competitors to get your name out which will facilitate re-entering the job market.
Get involved in activities such as volunteer or extracurricular to get people familiar with you and your name.
Have a going away party for yourself with the objective of breading familiarity Amongst your peers and superiors.
Not only send a letter of resignation but a letter of thank you to your boss and superiors detailing your appreciation for what you learned and also how this travel opportunity will enhance your job skills (you are setting the stage for a possible rehire or reference).

Confused and lost – if your career is not set.

Have a candid discussion with your superiors prior to advertising your leave to identify your weaknesses and strengths.
Network amongst peers and competitors in your current job field and different job fields.
Look at job boards to see what kind of jobs are available and what are the criteria needed for these jobs.
Seek out possible jobs (lifeguarding, teaching other sports eg. Soccer/football, etc, teaching languages or other subjects, marketing opportunities, IT/computer related fields, blogging, tutoring on-line, consulting jobs on-line, etc ) and establish ahead of time what you plan to learn from these odd jobs based on identified weaknesses and or strengths bearing in mind the need to build your resume upon return.

Family.

Have an honest discussion with family explaining why your decision is being made and what you hope to get out of it.
Establish who is foreign who is against you going and their reasons, try to assuage those against but be aware that they may never understand your reasoning.
Consider a tracking device on your Phone (FamiSafe, Family Tracker, Geo Tracker, life 360), which comes in handy in times of emergency so your family can track you.
Reconcile your life changes with loved ones, current relationships and prior relationships – reconcile all relationships in your mind and be comfortable with your decisions.

Travel young or older: pros and cons.

There’s much debate about when is the best time to travel, is it better to travel when you’re young or is it better to travel when you’re older. although the exact age is that qualify for a description of “young” versus “old” can be left up to individual interpretation. At either age most are searching for Happiness and personal fulfillment to some degree.

Traveling young < 30 years old.

No responsibility – You have fewer responsibilities and obligations, financial and otherwise. This is a perfect time to travel on a slim budget, stay in hostels and couch surfing with likeminded people. It’s great not leaving anything behind that could lead to consequences if unattended.
School’s out! – You have finished school – high school and college and possible second degree. You don’t have to think about deadlines or requirements or expectations. This is a great time to evaluate your education and possible next steps with a mind not bogged down with a to-do list.
No career yet – You have not established your career nor a network. Sometimes it can be difficult to abort a career that is on a trajectory and so having the chance to travel before this occurs should be seized.
No babies, no kids, no spouse! – You do not have young children or spouse to consider in your plans. This is a no-brainer, you are free to travel!
New friends – Exposure to other cultures at an impressionable age. Meeting people from different cultures during your travels who are either local residents or other travelers can provide eye opening experiences with exposure to different ways of life, diets, styles of communication and even relationships that can be lifelong.
Finding you! – Development of self-awareness and your personal identity. All of the above reasons given can help to contribute to your having a better understanding of who you are.
Character and personality work – Development of humility and tolerance from exposure to other cultures. With exposure to other cultures, through understanding an appreciation of differences you learn tolerance, and empathy which can greatly impact positively your future relationships and negotiations.
Exposure and clarity of mind – Exposure to environments, relationships and cultures that can contribute clarity in life decisions. New exposures and unhindered freedom to be, can help you to see and understand experiences and declutter your mind.
Funky attitude be gone – Helps with working through personal challenges such as depression, loss or grief. Having clarity of mind without obligations can you help you to process your thoughts and emotions.
Real life experience – Provides real life experiences and tools for development of your careers. On returning to start or resume your career, these experiences are invaluable and make you very competitive and desirable for employment. In this global environment that we live in, this could increase your chances of a remote job or a traveling job.

Real Stories from Young Travelers Abroad

Traveling older >45 years old .

Time on your hands – You may be newly empty nested and have more time on your hands. When you’re not soccer mom anymore, not cleaned house not making dinner you realize you have no social life it’s out of your kids and you have no idea what to do with your time. This is a great opportunity to start fresh on a new slate.
Mid-life changes – Your career may be stagnant, and you need to consider a career change or maybe retirement. This is a great time too set goals, evaluate your past accomplishments, happiness factor and dreams.
Mindfulness & Self-discovery – You may be recently divorced or otherwise single, on a search for self-discovery. It’s time to re-introduce yourself to yourself, and learn more about your likes and dislikes, learn how to treat yourself for what you deserve to have and be. It’s time to learn to be present and in the moment and realize that self-love is not selfish.
Self-actualization – may need time away for rejuvenation, mindfulness, renewed spirit. practicing yoga, meditation, mindfulness and enjoying being present in the moment helps with personal growth and development.
Bucket list items – Have a long list of Bucket List places to see and go. Meeting people with a new sense of purpose, worth and value can open your eyes to experiences you would never previously have imagined. Be open!
Enjoy life – You have saved enough and it’s time to enjoy life. You have planned and saved and now it’s time to enjoy your life. It’s no time to reinvent the past, nor ruminate on the past, nor beat yourself up about missed opportunities or stack up regrets.
Step outside of your comfort zone – Push your boundaries and push yourself can your achievements. Pushing your boundaries beyond your comfort zone will give you a phenomenon you sense of accomplishment find achievement and personal value.

Best Friends (Real Friends)