We are delighted to feature submissions from our Member community, and today we are excited to share one by Carolyn Parse Rizzo, a longtime FIGT supporter, conference attendee and 2018 Conference Presenter.
Many thanks to health psychologist Vivian Chiona, founder and director of Expat Nest, for her important contributions to this article.
By Carolyn Parse Rizzo
It can be extremely stressful when we or someone we love becomes ill abroad. As well as the (very normal) physical and mental turmoil of illness, we also find ourselves dealing with additional challenges that are unique to international life.
At the 2018 Families in Global Transition (FIGT) conference in March, psychologist Vivian Chiona (Expat Nest) and I got together for a “Kitchen Table Conversation” on exactly this topic.
Participants included missionaries, financial planners, educators, executives, researchers, writers, coaches, artists, and others within the international community. They were also parents of children with serious medical conditions, spouses to partners with a serious illness, or medical patients themselves.
Swiss, Canadian, Italian, Austrian, Australian, English, Israeli, American, African, Belgian, Taiwanese, and Dutch passport holders have all contributed to this ongoing discussion.
8 Common Concerns of Expats
Below are eight common concerns that emerged from this fascinating discussion with expert expats and expat experts alike! In Part II of this article, we offer four overarching strategies that are packed with opportunities to get you through, or altogether avoid, these potential roadblocks.
Participant Michael Watkins, an expat who experienced a life-threatening medical crisis while traveling in Switzerland, named the first three major challenges faced by expats and travelers who experience health issues.
In the true sense of the word, many expats and travelers, have little, if any, knowledge or information about the local healthcare system until they are faced with a crisis. The process, coverage, and payment protocols differ greatly from country-to-country, but we often make assumptions that our healthcare experiences will be similar to those in our native country (or our last country of residence).
Regardless of the outcome, assumption and lack of knowledge add undue stress to an already stressful situation.
One mother described a scenario where she made daily trips to the ATM machine in the hospital where her preschooler was admitted. Every day, she'd withdraw the maximum, thinking she would have to pay thousands for her child's five day hospital stay. Her husband was out of town. She'd been studying the language, but it wasn't enough to understand the process.
In the end, she was charged only 60 euros, the price of her meals while accompanying her child.
Though this was a welcome and pleasant surprise, her own assumption and lack of knowledge caused needless anxiety.
2. Insurance, Financial Burden
The wrong insurance (or no insurance) can lead to a personal financial crisis. Those who have been through a medical crisis abroad, stress the importance of understanding the host country's local medical coverage and how it interacts with private insurance carriers, including medevac coverage and pre-existing conditions.
An American couple traveled all over Europe believing they were covered by Medicare. After one sustained a serious bicycle accident, broken bones, head injury, and week-long hospitalization in Italy, they learned that Medicare did not cover them outside the United States.
While they were not denied care, the stress of trying to navigate how they would pay these international bills while also figuring out how to transport her seriously injured husband home for surgery (where it was surely covered) was overwhelmingly stressful.
Another traveler described the financial barrier he and his wife faced in Spain when "the hospital demanded upfront payment for most of the cost" of a surgery and hospitalization after he sustained a fall.
In this case, they were covered by insurance, but were forced to use credit cards at admission and would not be reimbursed for some time, causing a period of financial hardship. Additional room and board costs were not covered.
Sometimes you get lucky like Watkins who explained how he learned, after the fact, that his private insurance covered not only his private room, but higher quality medical equipment, medicines, and food during his lengthy hospitalization in Switzerland. This detail varies from country-to-country as well.
Almost everyone described the sense of isolation and lack of support they felt being far from a personal and professional support system. Whether alone for weeks in a stark hospital room, recuperating at home as a single, without the support of close friends or family, or posted in a remote area, far from quality facilities, isolation can be a major obstacle to recovery.
Lack of emotional and logistical support (e.g. like someone to collect kids from school, run household errands, or cook) contributes to this sense of isolation. Without a close support network, individuals and families dealing with a medical crisis abroad can feel unmanageable stress and fatigue, decreasing their ability to cope, make decisions, or maintain a positive outlook.
In addition to the challenges born out of Ignorance, Insurance, and Isolation, issues related to Trust, Communication, Overwhelm, Parenting, and Pain also came up in our Kitchen Table Conversation. While several of these may be true for anyone facing a health crisis, we agree that it is the interplay between them amplifies the overall challenge, creating a unique experience for expats in this arena.
Or rather, miscommunication, or misunderstandings with healthcare providers due to a language barrier or cultural differences in communication styles and expectations is a real roadblock. Even routine check-ups and screenings can be put off or missed altogether.
For some, these misunderstandings lead to a general mistrust of the medical system, itself. Once this has happened, it can be hard to reconcile, to return to the same system when a need arises again.
Trust can be difficult to cultivate when communication is a struggle, but when a patient's symptoms are not believed or validated, or where a misdiagnosis occurs, a patient is left to suffer both physically and psychologically, as described by more than one participant.
When a patient is empowered and knows themselves well, not being believed, heard or helped when they are suffering is even more maddening.
There could be a cultural or individual bias at play and the solution may be as easy as switching primary care physicians or specialists, but overcoming mistrust of an entire medical culture is a heavy burden for those who must continue to engage with the system.
6. Overwhelm and Indecision
Some described a sense of paralyzing overwhelm when they received news of a new diagnosis; a long list of tasks to complete within a limited time-frame, under stress, not knowing how or where to begin.
This feeling can lead to indecision or the "freeze" stress response in which no action is taken whatsoever.
Another version of overwhelm is "analysis paralysis" where the person who must make the medical decision becomes overwhelmed by all the information and possible pathways, becoming stuck and unable to move forward.
7. Complex Parenting
There are a myriad of scenarios that make parenting more challenging when there is a health crisis in a family. If one parent must split time between hospital visits and home routines, but they are lacking social-emotional support themselves, stress levels rise even higher. Finding time to recharge seems nearly impossible.
If it is a parent who is injured or ill, children may also need extra emotional support at a time when the parents’ emotional reserves are low. It may be overwhelming to think about how to talk to the children about what's happening or to know how much to share.
If the child is the patient, there are often social-emotional and scholastic implications that arise, in addition to the physical issues. Depending upon where the family is based, there may not be access to necessary medical care or support services. A career may be cut short, siblings lives suddenly up-heaved.
A couple of parents described hasty departures and medevac rides, uprooting in search of a posting that could support their family's well-being.
8. Pain and Discomfort
Anyone who has experienced acute or chronic pain, understands how it can dominate everything else listed here. Aside from learning how to survive and thrive physically, patients and their loved ones reported feelings of guilt, self-blame, doubt, sense of loss, grief, anxiety/depression, hopelessness, helplessness, and fear.
How human pain (both physical and psychological) is interpreted and treated varies widely between cultures. Some cultures medicate for every ache, while others hold off on pharmaceuticals. Some systems provide substantial patient support services, while others provide only essential medical care. Non-pharmaceutical pain management options may be suggested, but no coaching provided on how to implement them.
Finally, mental health is not always covered by the local system and if it is, it may be difficult to find a local therapist in one's native language. Culturally, the role of a psychiatrist may be primarily to prescribe medications without therapy and monitoring, so those seeking both may feel like they're falling through the cracks.
If you are considering seeking professional support, working with a professional coach or psychologist online or via telephone is another option. There are virtual "offices" where you are invited to express and explore your thoughts and feelings about your health journey, develop coping strategies and ultimately experience more satisfaction, peace, joy, and vitality in your life.
A Certified Child Life Specialist can support you, your children, and teens through a medical event or illness by helping you design an effective coping plan and providing age-appropriate explanations of diagnoses and medical procedures.
What would you add to this list of challenges? What insights do you have for crossing cultures with a medical condition?
Continue on to Part II, where we explore strategies and solutions to some of these challenges, as well as unexpected opportunities.
Carolyn Parse Rizzo is a Certified Child Life Specialist and life coach for global families facing health challenges and change. She hosts a quarterly Vibrant Women's Circle for expat women in Northern Italy where she lives with her cross-cultural family. www.intervallifecoach.com