NHS Scotland Global Citizenship Doing It Well

Section 3 – Preparing for Going Overseas

If you decide that you want to participate in global health work that involves going overseas, you should give careful consideration and planning to the following areas:

What do you hope to achieve?

In order to make the most of the time you have in country it is important that you discuss and agree your objectives and expectations with your host.

Asking for leave from work

Speak with your line manager as early as possible to discuss your global citizenship plans. Your line manager will be able to discuss ways in which they can support you including referring you to the different HR policies that are available including: annual leave, paid or unpaid special leave, study leave etc. Read the NHS Scotland Global Citizenship HR Guidance, which provides information on current HR policies to support your global citizenship participation.

Financial Implications

Work out how much the trip will cost you (if not covered by an organisation).

• Travel
• Travel insurance
• Time off work if unpaid
• Visas
• Health costs such as vaccines and anti-malarial medication
• Accommodation and within country travel
• Are you a caregiver, if so, who will undertake these roles when you are away? Will there be extra costs as a result?
• If you are volunteering for a longer time, will this have implications for your pension?

Family

Things to consider:

• are you using holiday time which you would normally spend with your family to volunteer overseas, will this have implications for their holiday?
• are you a caregiver, if so, who will undertake these roles when you are away?
• discuss with family and friends early – are there any big events or occasions that you may miss?

Professional Registration

If you are planning to undertake clinical work, most countries will require you to be professionally registered with the local national professional council or equivalent regulating body. The Global Health Co-ordination Unit recommends that you register with the national professional council. This shows respect for national institutions and builds capacity within these institutions. The institution or facility where you will be working will be best placed to advise. Alternatively, if you are working with a charity or organisation they will be able to advise.

The General Medical Council (GMC), Nursing and Midwifery Council (NMC) and Health and Care Professions Council (HCPC) websites provide contact details of most overseas regulators.

Professional Indemnity

Whether you plan to work as part of a health partnership or with a charity or organisation you should ensure there is clear policy and guidance to specify where the responsibility for indemnity lies. Professional indemnity provided by CNORIS (Clinical Negligence and Other Risks Indemnity Scheme) is unlikely to cover overseas work so it is important that you arrange and pay for your own appropriate insurance cover. If you are responsible for your own cover, you can contact your usual provider to check what is required. The major UK indemnity providers do not generally provide cover outside of the UK, Australia and New Zealand. The institution or facility where you will be working will be best placed to advise.

In some cases, volunteers have been able to obtain professional indemnity at a cheaper rate by indicating that they are going to work in a low- or middle-income country. If working with a Health Partnership or a Charity they should be able to provide a covering letter to help facilitate this.

Travel Insurance

You will need reliable, comprehensive travel insurance if going overseas. Make sure that it includes cover for pre-existing medical conditions.

Handy Tips:

• save the emergency contact number and policy number in your phone
• share the insurance policy with a colleague who is travelling with you and with your emergency contact at home
• email the insurance policy to yourself or store remotely in case you lose your devices

Travel Deals

There are opportunities in the travel industry to secure cheaper/flexible fares for travellers flying for humanitarian purposes. Some travel agencies have negotiated humanitarian fares with major airlines.

What are Humanitarian Fares?

While not always the cheapest they are always the most flexible. They offer a larger allocated amount of baggage; they often have a large hold period (about 11 months) where you can hold the flight you want before booking and you can change or cancel the flight after your final booking for a small fee. For some agencies, you don’t have to pay any transaction fee for booking a humanitarian fare.

Travel Advice

The best way to get objective, specific and up-to-date travel advice for the country you are planning to visit is to consult the Foreign, Commonwealth and Development Office (FCDO) website. If you don’t follow the advice from FCDO it can invalidate your travel insurance.

Complete the foreign travel check list early in the planning stage of your trip, this includes entry requirements and visas, and advice about driving.

If travelling to more high risk destinations or for longer periods, you should register your presence in country with the UK Embassy or High Commission. This will enable them to reach you if there are any situation changes.

Living Arrangements and Lifestyle Restrictions

It is worth bearing in mind that working with overseas organisations may involve basic living arrangements alongside undertaking similar work. Other potential restrictions on personal freedoms may include alcohol consumption, style of dress, travelling at particular times or to certain locations, personal relationships and limited choices regarding diet.

In some countries it may be difficult to find somewhere safe to run or cycle or you may work during daylight hours and it is unsafe to exercise after dark.

Consider the following:

• find out about your living arrangements during your planned time overseas if these are being arranged for you
• are there any conventions regarding dress?
• if you regularly exercise, will this be possible while overseas?
• what are the local conventions on consumption of alcohol?
• if you have any dietary needs, such as gluten free or vegan, will the place you are staying be able to cater for these?
• check internet connectivity with your hosts, before travel. It may be cheaper to buy a local sim card rather than using your uk number

Knowing Your Environment

You can familiarise yourself with the country you are going to with the World Health Organization country guides.

Case Study: Paul Gowens reflecting on preparing for first visit to Zambia.

I had lots of experience in Emergency Medical Systems (EMS) internationally, in high income countries, so preparing for visiting Zambia, for my first time, was both exciting and daunting.

The most important part of my preparation was, 1) linking with colleagues at home who had in-country experience, and 2) connecting with key contacts in Zambia prior to travelling. This was so important in terms of building collaborative relationships and also from a health and wellbeing perspective so I didn’t feel isolated when in country.

I can’t emphasis enough how important it is to thoroughly prepare before travelling. Planning who and where are you going to, making sure you have your vaccinations and immunisations, handy things like keeping copies of vital documents such as passport, yellow fever card and insurance. Also important to think about how you will get about and what accommodation you are going to be staying in.

My visa needed to be paid for in US dollars on arrival at the airport, Kwacha as Zambian Currency can’t be taken into the country.

Many meetings can be ad hoc and once people know you’re there they will be very keen to meet with you. You have to be prepared to arrive with a very flexible itinerary.

I used WhatsApp as my primary communication method so having a sim card, data and WhatsApp are vital as soon as you arrive.

Immunisation

Travel vaccinations are now provided by regional NHS travel health services. Contact your local health board to book a travel health risk assessment, ideally 12 weeks before travel. NHS Inform can be contacted for more infomation. You can also contact a private travel clinic. Free NHS vaccines may include diphtheria/polio/tetanus booster, hepatitis A, typhoid, and cholera. Additional vaccines if needed are not free, and a traveller must pay for them, e.g. rabies, yellow fever. Anti-malarials also have a cost.

Some countries may have entry requirements which include evidence of having been vaccinated against some conditions such as yellow fever. Check the entry requirements on the Foreign Travel Advice site.

If you have a complex itinerary, underlying medical problems or are undertaking work in countries with a substantial risk of HIV transmission, you should consider seeking travel health specialist medical advice specific to your situation. This should include a discussion about post-exposure HIV prophylaxis.

Your local Occupational Health Department will be able to ensure that routine NHS vaccinations and immunisations such as hepatitis B have been given and are adequate (all clinical NHS workers should be vaccinated and checked by Occupational Health) and discuss issues around TB.

The Travel Health Pro provides advice by country.

Checklist

• Do you need vaccinations?
• Do you need anti-malarial medication?
• Do you have any long term medical conditions? How will these be followed up?
• Do you have enough medications to cover your trip?
• How and where will you access emergency healthcare?
• What is the healthcare structure?
• Do you have travel insurance to cover all settings and activities? It is important to note that some insurers will not cover infectious diseases contracted while working.

Looking after your Emotional Resilience

How you will cope working and living in a different country is a question you need to consider when contemplating undertaking volunteering in resource-poor environments. Sometimes language barriers, cultural differences or experiencing extreme poverty for the first time can have a profound effect on your wellbeing. Here are some steps you can take to prepare:

Consider the impact of living away from your home and family on your mental health, especially if you are going to a remote area and have never lived abroad before. You may find yourself feeling lonely or stressed. It is important therefore to have a good support structure, in your new country and at home, that you can turn to if you need help. Consider networking with other volunteers in the area for peer support.

Steps you can take:

• speak to previous volunteers and NHS Board Champions who have worked in the country you are planning to travel to
• invest in a good guide book and research cultural information
• learn some important phrases in the local language
• try to stay open-minded and not have too many preconceptions about the place you are planning to work
• make sure you have an emergency contact in country and at home should you need it for any reason
• during your visit, plan how you will communicate with your hosts on your return, consider what method of communication will be most convenient and cheapest for them, what time of day will fit with your and their schedule best, taking into account time zones