My Students Aren’t Getting Malaria; They’re Getting Pregnant

We get a lot of questions about personal safety from potential volunteers, especially since September 11th, the war in Iraq, and continuing terrorist acts around the world. The reality is that, despite the headlines, it’s still very safe to travel abroad. For Cosmic Volunteers especially, our volunteer areas are very safe, and we’ve never had a serious personal-safety issue in our 3+ year history.

But, what are some of the major safety issues abroad? The following Wall Street Journal article has some answers that may surprise you.


Sex, Drugs and Junior Year Abroad: Doctors Work to Protect Travelers


July 31, 2003

As kids trek through Europe on post-graduation jaunts or plan soul-searching trips to Nepal and junior years abroad, many parents are probably worried about terrorism and mysterious viruses.

They’re nervous about the wrong things. The real scourges of overseas travel are far more mundane: pregnancy, drug use and mental illness. Now, doctors, colleges and youth-travel programs are stepping up their efforts to prevent these problems.

Sure, kids get into trouble with sex and drugs in their dorm rooms, but recent studies have confirmed what travel doctors and educators have long suspected: The risks rise with travel. Removed from friends, family and school and faced with the challenges of a new language and culture, even stable young adults can fall into dangerous behavior.

“My students aren’t getting malaria; they’re getting pregnant,” said Susan Anderson, a travel-medicine doctor at the Palo Alto Medical Foundation.

In one ongoing study of young travelers to Southeast Asia, 75% said they took drugs during their trip, according to the study’s author, Israel Potasman, head of the infectious-diseases and travel clinic at the Bnai Zion Medical Center in Haifa, Israel.

In another study published in the Journal of Travel Medicine by Dr. Potasman, 11% of young travelers had an episode of psychiatric symptoms, including sleeping disturbances and depression, during their trips, compared with only 2.3% who had sought treatment before travel.

Colleges are focusing more on these tough and often delicate problems because of the soaring popularity of studying abroad. The number of students studying overseas has jumped 55% in the past five years, according to the Institute of International Education in New York. And that doesn’t include the legions of kids taking off on their own trips — a favored choice for jobless graduates who are waiting for the economy to improve.

These days, physicians such as Dr. Anderson send women off with a prescription for pills that can be taken after unprotected sex to prevent pregnancy. Princeton University added a feature to its Not-2-Late Web site during the past few years that lets students see what types of emergency contraceptives are available in each country they are visiting.

At the University of Chicago, administrators try to identify students with mental illnesses and then make sure at-risk students have adequate medication. They sometimes even make advance appointments with psychiatrists and therapists at the students’ destinations.

A leading study-abroad program, the Institute for the International Education of Students, has hired 20 new staff members during the past three years, primarily to deal with a surge in health and safety issues (depression and allergies are the top two) among the 3,000 college students it sends overseas each year.

About five years ago, the program had to bring six students home because they had developed severe anorexia and bulimia; it hasn’t had to evacuate any students for eating disorders since the new efforts were put in place.

Of course, travel is a positive experience for most kids. They learn new languages, open up to new cultures and become more self-sufficient.

But doctors say the everyday stress of having to find a place to sleep, eating strange foods, figuring out train schedules and witnessing poverty can be a catalyst for depression, anxiety or an eating disorder.

Doctors also cite a “magical thinking” phenomenon. “The environment is so different that there’s a subconscious feeling that what they do doesn’t really count,” says David R. Shlim, medical director of the Jackson Hole Travel and Tropical Medicine clinic in Wyoming. “So they do stuff they don’t normally do, such as have more casual sex, ride a bike without a helmet or ride a motorcycle while barefoot.”

As young strangers travel together, what Susan McClellan at Tulane University Health Sciences Center calls the “love boat thing” can lead to casual sex. Studies estimate that about 2% to 10% of returning travelers have acquired sexually transmitted infections while abroad.

More troubling, sexual assault is not uncommon during travel: It is one of the top reasons students need medical evacuations during their trips, according to International SOS Assistance Inc., a provider of travel health-insurance policies.

In response, some doctors encourage young women to carry emergency contraceptives in case of sexual assault, though other doctors say that the pills should be used under medical supervision.

Some medical-school students and relief workers get prescriptions for antiretrovirals, pills that can prevent HIV transmission after a potential exposure. Dr. Anderson in Palo Alto also prescribes the medication for women taking extended trips to rural Africa (where HIV rates are high). But the medication is expensive, has serious side effects and needs to be started almost immediately after exposure.

Young people often encounter novel and exotic drugs overseas, and they may be more willing to try these drugs since they carry less of a stigma at home. While most study-abroad programs have long had strict drug policies and pretravel lectures, some schools are enhancing their efforts.

There is little that can be done — beyond preaching common sense — to prevent the No. 1 causes of death and injury during travel: motor-vehicle accidents and drownings. But there are many steps kids and parents can take to prevent health problems abroad.

First, check with your insurance company to make sure coverage applies while you are overseas. You can take out extra insurance from companies such as International SOS or Medjet Assistance to cover emergency medical evacuations.

Also, check with a local U.S. embassy to see where its staff gets medical care. International SOS operates clinics staffed by Western-trained doctors. IJET Travel Risk Management sells country reports that detail safety and health issues and gives information on the best hospitals and clinics.

Young adults and their parents should honestly evaluate their mental health, the stresses they could face, and the support and medication available at their destination. They should also set up an e-mail and phone-support system with friends and family before they leave, so they have a familiar person to turn to.

Check with family doctors, travel specialists or student health services to see if they do e-mail consultations. Many doctors now answer e-mail for patients, often without an extra fee.