Safety in Study Abroad: How Much More Can Programs Do to Protect Students?

by Kyna Rubin

This article appeared in the February/March 1998 NAFSA Newsletter.

David Larsen, director of the Beaver College Center for Education Abroad, arranges for students he sends to Belfast to ride through the toughest areas of that Northern Ireland city. "Shortly after their arrival, we drive them through the dangerous neighborhoods so they can see for themselves the parts of town to avoid."

The Pennsylvania-based program has sent thousands of students abroad since 1965. Larsen says his staff have dealt with a range of crisis situations, from the 1989 Lockerbie, Scotland crash (a Beaver student was on the plane) to Saddam Hussein's threats against Americans during the Persian Gulf War. "Our experience has given us a pretty good sense of what we need to tell students and ourselves about safety issues," says Larsen.

Indeed, for years the Beaver College Center has had in place policies and procedures to help protect students from accidents that are preventable and to respond to those that aren't. For example, Beaver's on-site orientations in London address British traffic patterns, pub culture, drug laws, and the kinds of things that can happen when walking down a street alone at night in a foreign city. In case of terrorist or other threats, Beaver has evacuation plans for each overseas site. Says Larsen, "We had these in place even before the Gulf War," which, for many other programs, was a catalyst for developing such plans.

Larsen is one of many study abroad program managers who carry out the kind of best practices that all U.S. study abroad programs might consider adopting if they haven't already done so. No matter how prepared universities and third party providers of study abroad may think they are to protect students' health and safety overseas, illness and accidents can strike anywhere, anytime-even on programs with comprehensive safety plans.

"The person who gave me the best materials on safety and risk management was from the Semester at Sea," says William Cressey of the Council on International Educational Exchange. Semester at Sea lost four students in a bus accident in India in 1996. "No matter what you do to prevent such tragedies, there's an element of luck involved," says Cressey, who recently convened a task force to draft guidelines on health and safety for study abroad programs.

Nonetheless, study abroad managers suspect that some study abroad programs do a more thorough job than others in briefing students on these topics and preparing on-site directors to handle a crisis. No one knows how many campuses have emergency/crisis plans in place, says Brenda Robinson, co-chair (with David Larsen) of NAFSA's Section on U.S. Students Abroad's (SECUSSA) subcommittee on safety and responsibility. But she and others believe that small programs and those new to the study abroad business may have the steepest learning curve when it comes to health, safety, and liability issues. And even programs with carefully conceived student orientations and crisis management plans can always improve and update their policies.

No program can adopt another's orientation and safety plans wholesale. A university that sends students to take classes on a campus in Paris and one that sends young anthropologists to do fieldwork in rural Mexico will obviously require different kinds of safety plans. But the study abroad community can learn a lot about generic safety and health strategies from people who've thought long and hard about these issues and have created or implemented crisis plans themselves in a variety of overseas contexts.

Getting Students to Behave Safely

Many of the more common illnesses and incidents experienced by U.S. students overseas are behavior-induced and therefore preventable, say study abroad administrators. Getting mugged while out alone after drinking late at night in a foreign city is one example of avoidable risk. The first step toward protecting young people from their occasional lack of good judgment and false sense of security is to arm them with knowledge about safe behavior overseas. Rodney Sangster is regional director of the Universitywide Education Abroad Program at the University of California-Santa Barbara. He offers both predeparture and on-site orientations to 1,700 UC students each year who study in 30 countries. He says that briefing students on behavioral and cultural issues once they're on site is much more effective than trying to get their attention beforehand.

Says Sangster, "You can talk yourself blue in the face to students about health and safety before they get to the country, but it's not until they arrive and live there that they really start listening to what you're saying."

Sangster argues that briefers need to get very specific about safe and unsafe behavior at the on-site orientations, which UC's program conducts within the first four days of students' arrival overseas. For instance, the program talks to students about the kinds of sexual behavior that can invite trouble in a particular setting. In Mexico, Spain, and Russia, Sangster has native female staff talk to the women students about how to dress and behave to avoid unwanted attention. Behavioral issues are also addressed in-country during UC's six- to eight-week intensive language program. "Students absorb more in the second week than in the first, and more in the third than the second," says Sangster, "because they're experiencing the culture firsthand."

Beaver College's David Larsen says that students on his programs often think they're safer abroad than they are at home, so aren't always as cautious as they might be. "I can think of many instances where students were drinking and did stupid things," he recalls. His students are briefed repeatedly on how to behave in a particular culture-in predeparture country-specific materials and at a three-day on-site orientation. "We give them very specific advice such as `don't go out alone.' In Belfast, we tell them to stick to places that Northern Irish students go to, in order to avoid violence." Such warnings tend to keep some of them out of trouble, according to Larsen. "Accidents such as getting robbed, pickpocketed, or hit by a car are unfortunate but most are preventable by exercising the kind of caution we encourage them to use." He adds that it's sometimes easier to teach students about personal safety in places like Northern Ireland where violence has occurred than in cities that don't make the headlines.

The head of one study abroad program that has been sending students around the world for over 40 years agrees that students can sometimes be their own worst enemies by not heeding precautions spelled out to them by program briefers. "I can think of hardly any really serious incidents that have occurred on our programs that couldn't have been prevented," states John Sommer, dean of the School for International Training in Brattleboro, Vermont. SIT is part of World Learning, formerly known as the Experiment in International Living. The school sends the majority of its 1,300 students a year to Third World countries; about a third go to Africa. All SIT students conduct field study together with classroom seminars.

But Andrea Walgren, vice president for student affairs at the School for Field Studies, knows firsthand that some tragedies may not be preventable. Her Massachusetts-based school sends 700 students a year to six centers located in endangered ecosystems around the world for hands-on, field-based environmental study. In 1996 a student drowned in Costa Rica off a beach he was told had dangerously strong currents. Says Walgren, "You can inform students about dangers in an area but you can't ban them from leaving center grounds or make all their decisions for them."

The School for Field Studies, in business for 18 years, prides itself on elaborate and thorough safety and crisis plans. Staff require students to engage in their own risk planning, to complement the school's own intricate safety procedures. "As part of students' problem-solving curriculum, we have them think through field hazards and means of dealing with them," says Walgren. On Vancouver Island, for instance, two students who wanted to leave the center on their day off from structured activities asked to go fly fishing. Walgren says the two were required first to come up with their own risk management plan, including potential hazards Asuch as how they'd deal with bears and hypothermia." According to Doug Brown, the school's full-time risk manager, no matter how well a program may brief students on safety, young people will still sometimes make the wrong choices. It's part of the process of becoming an adult, he says.

Perhaps no program has more experience sending Americans into potentially hazardous parts of the world than the Peace Corps. That organization has been briefing volunteers on potential safety and health hazards for 36 years. The growing number of American students going abroad for fieldwork instead of or in conjunction with classroom instruction makes the Peace Corps' experience with safety abroad relevant for many study abroad programs. "We talk about behavior modification right away to our volunteers," says Peace Corps spokesman Brendan Daly. During 13 weeks of in-country training, Peace Corps briefers teach language, technical skills, culture adaptation strategies-and safety. They tell female volunteers that jogging alone may not be safe in many countries. And they discuss appropriate attire. This year for the first time the Peace Corps sent volunteers to Jordan, where women recruits were told not to wear shorts and t-shirts.

Daly explains that the Peace Corps would rather volunteers pack their bags for home if they're frightened by what they hear about health and safety issues in the host country, than be uninformed and surprised at things that happen. "Information is power," he says, "and we believe in being up front."

Peace Corps volunteers, most of whom are a self-selected group of individuals who are sensitive to the local culture, are still not invulnerable to making poor behavioral decisions. Daly says that sometimes after a long stretch in a rural area, volunteers go into a city for vacation and do things they wouldn't ordinarily do in their rural community. Peace Corps volunteers have been attacked, mugged, and stabbed. It's generally not the volunteers' fault but sometimes these things are preventable, he says.

Preventing Road Accidents

The single greatest threat to traveler safety overseas is road accidents, according to Rochelle Sobel, whose 25-year-old son was killed in a bus accident in Turkey. She argues that most study abroad programs alert students to health risks, crime, and political unrest but fail to inform them of the hazards of foreign roads. According to Sobel, deteriorating roads, hairpin curves with no guardrails, inadequate signs and lighting, disregard for traffic laws, and poorly maintained vehicles are commonplace in many countries where American students travel. As the result of her family tragedy, about two years ago Sobel founded the nonprofit Association for Safe International Road Travel (ASIRT) to help travelers make informed decisions about road transportation.

The Peace Corps' Daly concurs with Sobel. He blames road accidents for many of the deaths that have occurred worldwide among Peace Corps volunteers. "We discourage volunteers to ride on motorcycles and forbid it in some countries, because of accidents in the 70s and 80s. This policy has lowered our death rate to two to three a year over the last five years."

ASIRT has been campaigning to get the State Department to include information about road conditions in its travel advisories, informing universities about the association's country road reports, and urging popular travel guides to refer to ASIRT as a resource. George Washington University's Adrian Beaulieu, director for study abroad, recently started ordering ASIRT's reports for Spain and Morocco. According to Sobel, some 50 other universities have also become association sponsors, who for $50 a year receive updated road reports for five countries.

Creating Safety and Risk Management Plans

In a perfect world, study abroad programs flood students with accurate information on safe behavior and travel modes, students dutifully follow all advice, and nothing untoward affects their overseas experience. But we live in an imperfect world, where accidents can happen regardless of how much we do to avoid them. So it is crucial for universities or study abroad programs to formulate safety/crisis management plans-to face the common types of accidents that are often preventable but may occur anyway, and the rare "acts of God" that are generally not preventable.

"Start with your on-campus plan," advises Brenda Robinson, who developed emergency procedures for the California State University system and is doing the same at Grand Valley State University in Michigan. She says that most universities have on-campus emergency procedures for dealing with rape and other crime. Institutions can adapt for use overseas many of the same processes and procedures they have in place to respond to emergencies at home.

Grand Valley's overseas crisis management plan has never been tested but arises from real life experiences that Robinson faced while dean of international education for the Cal State University system during the Persian Gulf War. In 1990 students on her program in Florence received terrorist threats nailed to their doors. "This ended up being a perceived threat rather than a real one," says Robinson, but it spurred her to refine emergency plans for the Cal State system as a whole and to help individual campuses determine how to assess whether an emergency is real or perceived and then what to do about it.

Robinson's philosophy is that "it doesn't matter how many students you're dealing with-2 or 250-you need to think about how you're going to handle an emergency" to meet your responsibilities toward students and toward the institution.

Elements of the safety and crisis plan she's developed for Grand Valley include establishing a comprehensive insurance policy for overseas emergencies that "will cover anything that needs to be done" including evacuation and repatriation (of remains); creating an emergency team on campus whose members are on call 24 hours a day; giving program directors and students a neon pink card with a country-specific number that gets them AT&T access to U.S. lines, and an 800 number that then allows them to call CIGNA International Advantage Executive Assistance Program (should they be unable to reach the home campus first); providing overseas directors with a corporate American Express card for emergency cash; and issuing to directors an 8 2" x 11" neon sheet with steps to follow in an emergency.

Grand Valley's crisis plans were designed by a team Robinson convened, comprising the provost, campus lawyer, public relations representative, dean of students, campus security officer, director of counseling, health director, and local travel agency staff. "You may not need to use all of their expertise in an emergency," says Robinson, "but it's important to have them involved in developing the plan."

Other study abroad administrators emphasize how important it is to gear a response to the specific level of risk, and to continually update crisis management plans. "We need to analyze a situation before deciding how to respond to it," says the University of California's Rodney Sangster. He's faced three levels of emergencies, from most to least serious, and responded accordingly. "We closed our program in Lima, Peru, when Shining Path guerrillas started bombing targets in the capital around 1990. We temporarily suspended our program in Jerusalem during the Persian Gulf War, because the city was within range of Iraq's SCUD missiles. And in 1997, in the wake of unpredictable suicide bombings on Jerusalem's main streets, we offered our students there the option of moving their studies to Haifa, though none took up our offer."

Reviewing and updating knowledge about an overseas site and safety/crisis plans are a matter of course for study abroad managers who take student safety seriously. Says Les McCabe of the Institute for Shipboard Education's Semester at Sea Program, "it's important to continually monitor our policies and procedures and update them as necessary, regardless if an accident has occurred."

Sometimes well-publicized accidents compel study abroad planners to rethink and enhance their own procedures. After St. Mary's College set up a counseling center at Dulles Airport for its returning students from Guatemala who had been robbed and raped off a rural road, George Washington University's Adrian Beaulieu decided that setting up this kind of satellite site to deal with an emergency might be something GW should consider doing if ever faced with a similar incident.

Training On-site Directors

A safety/crisis management plan may be initiated and designed by a home institution or study abroad program, but first in line to trigger that response system is the on-site director.

Two programs that put time and resources into training overseas directors in health, safety, and crisis management are the School for International Training and the University of California study abroad program. SIT brings its overseas academic directors back to Vermont once a year-and its newer directors twice a year-for briefings that include health and safety issues. These meetings comprise sessions on student insurance and medical evacuation, crisis management, sexual harassment (including cross-cultural dimensions, reporting requirements, and case studies), and health.

"We probably do more on health and safety issues because we operate in riskier settings than programs based in Western Europe," says John Sommer of SIT, which operates 55 programs worldwide. He says that his programs are personnel-intensive and that the attention to health and safety issues has paid off. AWhile we inevitably have had illnesses and safety concerns, we've been relatively lucky so far."

Using case studies is one of the most effective strategies for training overseas directors, notes UC's Rodney Sangster. At UC's annual three-day orientations, staff place new directors in a circle, present a case study, and ask them how they'd handle the situation. "They often tell us this is the best part of the orientation-sitting around and learning how to make the right judgment call. We tell them there is no right or wrong way to respond to such situations, but there is an appropriate way," says Sangster.

One area of training not sufficiently addressed, according to Sangster, and one that his own program plans to enhance, is sensitizing faculty directors-and native staff-to refrain from casting judgment about a student's behavior-induced predicament. "There is a tendency for some faculty to say to the student, `See, I told you such and such would happen,'" explains Sangster. He tells directors their first task should be to make sure the student is all right and gets the support he or she needs.

"How many times has someone in a position of responsibility abroad had a young woman in his office complaining about being the victim of unwanted attention?" recalls Sangster. "The student is dressed in a short skirt and halter top in a very conservative developing country. The director's responsibility is not to criticize her but to ensure that she is treated with respect and that she is properly oriented about her behavior."

Sangster cites the example of one such female student in Mexico who was unhappy on the program because of unwanted attention she was attracting. The foreign director of the program spoke with her frankly and in a nonconfrontational way about appropriate dress. Once she changed her attire, she started having a wonderful time, says Sangster.

Learning About Health in Foreign Countries

Just as students can increase their own safety abroad by following program advice about safe behaviors, so, say study abroad experts, can students decrease their chances of getting ill or injured while overseas. But students' knowledge about health and medical practices in host countries is only as good as the information they hear from program administrators. And program staff often don't have a lot of data to draw on, beyond Centers for Disease Control and Prevention health advisories for foreign countries.

"There's a lot of research on travel health-getting adequate sleep and adjusting to a new time zone, but little about what happens to college students abroad," says Mickey Scullard, a Minnesota health educator and onetime student adviser who wrote her master's thesis on health issues for American study abroad students. Most studies, she found, are geared toward older travelers, Peace Corps volunteers, or military personnel.

A survey she helped develop of over 200 study abroad programs found that only 37 percent had a record-keeping system for the incidence and prevalence of health problems students face abroad. Scullard concludes that developing health promotion materials without hard data may not bring about the changes in students' behavior necessary to reduce overseas health problems. Information, she says, should target injury prevention, mental health issues, and sexuality topics-areas of heightened risk for college students.

College students abroad are a unique group with unique health problems that should be better tracked, says Scullard. For instance, they go overseas for six months or a year-shorter amounts of time than Peace Corps volunteers but longer than tourists. "Yet students often have a tourist mentality. They feel invulnerable and are at a risk-taking, experimental stage of their lives." Moreover, when students go abroad they often take college-age-related problems with them such as alcohol abuse.

Anecdotal evidence, finds Scullard, suggests that few study abroad programs provide comprehensive health education beyond some information in predeparture orientations. And this usually targets infectious disease prevention in developing countries. That's important, says Scullard, but less serious illnesses such as colds and gastrointestinal upsets can color the quality of a student's overseas experience, especially in cultures that treat some illnesses differently than we do in the United States. Little to no information is being conveyed to students, says Scullard, about different countries' attitudes toward health issues. "Many of my former students who went to Great Britain and Ireland expected things to be the same there because of the English spoken, but they aren't. For example, the British don't give allergy shots like we do. So it's sometimes trickier sending students to places that we expect to be the same than to those we know are different."

Strategies for Protecting Student Health

Despite lack of hard data on illness among U.S. students abroad, there are ways programs can inform themselves and their students about health matters in host countries. Even ways to prevent some problems before they occur.

Take student medical forms, for instance. Some programs screen out students who disclose health problems that may affect their study abroad stay. The School for International Training follows up on applicants who report psychological problems or, say, asthma, when that student is going to a high-altitude location. SIT's medical form asks specifically how the applicant will deal with a stated health condition if it becomes acute overseas. And to discourage lying about illness on medical forms, SIT's Sommer is thinking about tightening up his health forms to say that withholding medical information could result in being dismissed from the program. AWe want applicants to know that there's a downside, in terms of their personal health and safety, to not being honest on their medical forms," he says.

Of the roughly 7,300 students SIT sent abroad between 1991 and 1997, says Sommer, too many have had psychological issues that they hadn't revealed on their forms and that became a problem in the field. "Often what happens is our on-site directors and the other students end up nurturing these students through their problems."

Peace Corps staff who come across applicants reporting serious health problems such as heart conditions or cancer examine each case individually. "We ask if we can support this person in the field," says Brendan Daly. "Some of the places we serve, like the mountains of Nepal, are a two-day walk from a hospital. We want to make sure we're sending people in good shape." His program tries to accommodate some psychological problems. For instance, in the last year or so the Peace Corps has "identified certain countries where we can provide counseling for volunteers."

How do experienced programs address the kinds of health problems that can strike the majority of study abroad students, who are healthy to begin with? Study abroad managers stress how important it is to supply students with site-specific information. For example, the School for International Training distributes to students health guidelines and requirements (based on CDC recommendations) that are specific to each of the school's 40 receiving countries.

The UC program that Rodney Sangster helps to coordinate provides a "very comprehensive" health orientation for UC students, especially those going to tropical climates. UC staff rely on a medical doctor on the UC/Santa Barbara campus who is well-versed in travel medicine and "knows the ins and outs of medical problems in developing countries from firsthand experience." The physician's hour-and-a-half briefing is videotaped for students who miss the presentation. "Our doctor has to keep current," says Sangster. "Things are always changing. For example, the prophylactics for malaria change every four to five years." UC also gives students copies of the International Travel Health Guide, by Dr. Stuart Rose. According to Sangster, students find this annually updated reference very readable and use it together with the CDC's Health Information for International Travel, which UC also relies on as the official U.S. government health reference.

The Peace Corps-one of the few institutions to keep extensive health and safety records-issues a report for its overseas staff called The Health of the Volunteer that, according to Brendan Daly, is updated yearly. Organized by region of the world, it contains statistics on illnesses, accidents, assaults, and deaths occurring among its volunteers-in some cases broken down by country.

Setting Health and Safety Standards in Study Abroad

No one can force the nation's study abroad programs into adopting optimal, uniform standards for preventing and responding to the illness, injury, or accidents that befall college students studying overseas. But the associations representing the study abroad industry, together with many of the larger study abroad providers, recently formed a task force whose members have drafted they hope will help study abroad managers, advisers, and students deal with the thorny issues of safety, health, and liability. The guidelines do not "break new ground," says CIEE vice president William Cressey, a leading player in the task force, "but codify practices that, by and large, already exist. We want to call attention to them because there may be small operations out there that don't do all of these things."

SECUSSA chair-elect Patricia C. Martin of the University of Pennsylvania views the guidelines as "a mechanism for establishing reasonable expectations" about health, safety, and responsibility in study abroad among students, parents, and program staff.

The idea for the guidelines was initiated at NAFSA's May 1997 conference in Vancouver by NAFSA, CIEE, and AIEA (Association of International Education Administrators) representatives. Last January 30 in Boulder, CIEE's Cressey gathered together representatives of about a dozen of the industry's largest third-party providers and members of SECUSSA's subcommittee on safety and responsibility. They spent a day plowing through Cressey's original draft, adding and refining language, with the goal of presenting the guidelines to the field at large and getting additional feedback. The draft was presented in February at AIEA's annual meeting in Monterey, and a more final version will be unveiled at NAFSA's 50th annual conference in Washington, D.C. in May.

"Can we impose these principles on programs?" asks Bill Cressey. "No. But by dint of leadership and peer pressure, you can put forward a set of principles that stands on its own merit and has so much backing that programs will find the principles difficult to ignore." Integral to garnering that backing, says Cressey, is securing the buy-in of the major third-party study abroad providers-which he believes is being accomplished by asking them to participate in drafting the standards.

Will these guidelines be formally endorsed by study abroad players? Cressey is in the process of securing such an endorsement from CIEE and assumes that NAFSA and AIEA will attempt the same. But official subscription to the guidelines may not be needed for them to have their desired effect. "You don't need a lot of endorsements before people will start implementing these principles," says Cressey. "It's principles like these that will, little by little, help improve the safety of the whole study abroad enterprise."