Going Abroad

Want to do a global health elective during medical school? Below is a step by step plan to get you started.  We are happy to help you in the Office of International Activities. Call for an appointment (428-3768) or stop by! (322A MacNider). You might also find some of these resources useful, or maybe through our links to other national and international organizations that past UNC medical students have participated in. Planning any kind of international project takes a considerable amount of time and energy, and its important to start the process early. It is not impossible to put together a good project in a few months, but you will be less frantic if you have more time. Moreover, sometimes a trip can fall through for a variety of reasons thus the earlier you plan, the more time you will have to work out the kinks or make other plans.

The beginning of your first year is not too early to begin thinking about what you would be interested in doing. Often overseas correspondence and project organization entail long delays-be patient and persistent.

For more information see our this Powerpoint presentation: "Getting the most out of a global health elective".

Step 1. Get a clear understanding of what your options are for electives during medical school at UNC

UNC medical students can do global health electives during:
• Summer between 1st and 2nd year for 4-6 weeks. Six credits are available for electives during this period and ONLY 6 credits from pre-clinical courses can be counted towards the 18 elective credits necessary for graduation. If you want to apply for financial aid loan money for your global health elective you need to register for the elective in the summer session (and you also must pay summer tuition). If you do not need financial aid loan money, you can register for the elective as part of your MS2 fall classes so that the tuition is covered in the tuition package, even though you will complete the elective and required class work and evaluation during the summer.
• As a 3rd year student, you can do one global health elective month (6 credits) ONLY if you postpone one of your clinical rotations (usually an outpatient medicine block) until the beginning of 4th year.
• As a 4th year student, you can do a total of two months (12 credits) of global health elective time. Generally, this would include two separate electives with clear objectives and learning opportunities. The best time is generally between January (after residency interviews) and March (before the required Capstone course). This needs to be carefully discussed with your faculty advisor and the Office of International Activities.
• Some students take a leave from medical school to complete an MPH or a specific global health fellowship program. This longer global health possibility (from 6-12 months) is an important consideration for students seriously considering a career in global health. You can take two years off medical school for any reason. Opportunities for extended global health work for medical students include:

Doris Duke Clinical Research Fellowship Program
http://www.ddcf.org/page.asp?pageId=12

NIH/Fogarty International Scholars Fellowship
http://www.fic.nih.gov/

If you have questions about or are planning on getting credit for your international project, you need to contact Leanne Shook (leanne_shook@med.unc.edu), 1001 Bondurant Hall. She can help coordinate the timing of the registration to meet both course requirements and financial aid guidelines. You will need to obtain an elective request form from Leanne and have your UNC faculty advisor sign it to register for an international elective.

Anna McDonald, Himalayan Health 2007

Step 2. Think about what you want to get out of the experience, and where you would like to go

There are many important reasons to do a global health elective but what you get out of it will at least partially be determined by what ideas you went into it with. Think about:

Why do you want to go? To broaden your life experience? To test the possibilities of devoting at least part of your medical career to international health? To experience and learn from another culture? To have opportunity to improve language skills? To serve others (or learn how to serve) with fewer resources and access to health care? To seek out information about the health and health care system of your own country of origin or ancestry?

What kind of experience do you want? Clinical, public-health related, or research? At what level, in what technical area, and in what type of institution? What do you hope for in a mentor/preceptor? Do you want to work with a group, or be integrated into ongoing care with nationals? What location preferences do you have: geographic, linguistic, nationality; urban, rural, or remote? If you are married or have a partner, what will they do, what are their views, and how will they share your experience?

There are established programs in many countries, and you can always create your own project as well. There are numerous resources you can use to find a program that might interest you. You can start with looking our list of programs and past student experiences and other organizations.

Please note that UNC Travel Policy determines the policy for whether students can be officially recognized (i.e., recieve credit, financial aid or UNC scholarship money) for going to a country on the State Department warning list. There is currently a list of countries that students cannot travel to and others need special waivers. If you need a special waiver, please contact OIA director Martha Carlough (martha_carlough@med.unc.edu).

Ross Boyce, Palestine, 2007 (side trip to Petra, Jordan pictured)

Step 3. Find a UNC faculty preceptor and an international preceptor/mentor

In order to register for global health elective or selective and receive credit, you MUST have a UNC faculty advisor who registers you for a specific elective course in their department. Possibilities for these courses are all listed in the electives catalogue (some are listed in the table below).

Any UNC medical school faculty CAN be your faculty advisor if they are able to sign off on your elective request, approve registration for you in an elective course in their department, and take responsibility for working with you to plan an appropriate learning experience, completing your evaluation and grade submission. The Office of International Activities will work with you and your faculty advisor to make sure you have the information you need to plan a great elective and that the paperwork for evaluation of your global health elective gets completed.

Several lists have been compiled, but the most up-to-date information can be found using the faculty search engine generated by the University Center for Global Initiatives. Enter key words to find the faculty involved in the international project or topic that you're interested in.

The UCGI also provides a collaborative agreements search engine giving "information on the international collaborative activities, partnerships, and research projects of the University of North Carolina-Chapel Hill," which may be helpful as well. Also check with the Institute for Global Health and Infectious Disease and the School of Public Health Office of Global Health for specific areas of interest and geographic experience of UNC faculty for ideas. Many faculty are willing to help with mentoring for international electives.

One of the best ways to find out who is involved in international projects is by talking with faculty members (teachers, ICM preceptors, Dr. Dent, etc.) and classmates or upperclassmen. They will all be glad to help you find what you're interested in.

Step 4. Make a schedule of deadlines - for a project proposal (if needed), scholarship/grant applications and applications to overseas placements, applications, letters of recommendation, and getting ready to go!

It is very easy, in the busyness of medical school, to get overwhelmed with paperwork and arrangements and to miss deadlines for getting things done. Global health opportunities are usually well worth the effort, but do require staying on top of things.

Step 5. Find and apply for funding $$$

Finding funding for going abroad generally comes from one of 3 sources: yourself, loans, or scholarships or grants. In most situations, a global health elective is going to cost some money out of your pocket. Funding for global health electives for medical students is limited, particularly for electives which are service-oriented. However, that should not deter you because there are a wide variety of scholarships and grants on campus that you can apply to as well as those through national organizations such as AMSA, AMA, or AOA that can help make your trip possible. It may take some effort and creativity to fit the piees together! A list of funding sources is available here to get you started. NOTE that if you are receiving a stipent from a STRT grant, or other NIH funded grant through UNC, you cannot get academic credit (it is considered work experience). But, with most other scholarships you can apply for academic credit.

If you are getting credit for your project abroad, you are eligible to receive financial aid. In order to receive financial aid before your trip, you need to apply for it at least 6 weeks prior to departure (and your elective request/credit application MUST be submitted before you apply). For questions regarding loans or other financial issues, contact Sheila McDonald. (sheila_graham@med.unc.edu), 1001 Bondurant Hall.

Step 6. Get ready to travel safely and be prepared for emergencies

Travel insurance including evacuation is required for all UNC students and faculty traveling outside of the US as part of academic credit or a work experience. You MUST obtain insurance in order to get credit for your elective or receive funding from UNC sources.

HTH (Highway to Health: http://www.hthstudents.com) is the provider of the UNC-sanctioned insurance. You must purchase this from Brian Moynihan (moynihan@med.unc.edu) in the Office of International Activities. At least two to three weeks prior to leaving, you need to schedule a brief appointment with the Office of Interntional Activities (brian_moynihan@med.unc.edu)  The daily premium is $1/day. If you need coverage before or after the dates of your project, the premium is $2.22/day. After you purchase the insurance, Brian Moynihan will send an email confirmation directly to the Office of Student Affairs stating you are able to apply for credit for the elective. You will receive an insurance card directly from HTH that you should carry with you when you travel.

UNC has a campus-wide policy defining issues of travel to countries for which the US State Department has declared travel warnings. (see UNC SOM Travel Warning Policy). This pertains to all currently enrolled UNC students who are receiving academic credit or financial support (grants or scholarships) from UNC for their international elective. All UNC SOM students need to review the US State Department information about the country (and in some situations city or specific area) and comply with campus regulations. (see http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html). You will need to sign a general waiver with the Office of International Activities stating you have read the information and that this travel is a voluntary part of your medical school experience. Usually, you can do this when you receive travel health insurance but if you have any questions about your intended travel plans and whether it will be possible, discuss this with your faculty advisor, OIA staff and the Office of Student Affairs before applying for any scholarships/loans or registering for electives.

In some situations there is not a US State Department complete restriction but limited travel warnings which are carefully and continually evaluated by UNC. If you would like to travel to one of these countries for a SOM global elective you will need to work closely with the OIA and special UNC waiver forms will need to be completed. If you are an MD/MPH student travel waivers only need to be signed in one school (SOM vs. SPH). Each situation will be considered individually, in conjunction with the Associate Provost for International Affairs and the University Counsel’s Office.

Passport and visa information is available on the US Dept. of State’s site: http://travel.state.gov. You should have a passport that is valid for at least 6 months beyond your return date and you register your trip with the Dept of State (see: https://travelregistration.state.gov/ibrs/ui/) You should also have contact information for the embassy/consulate office in the country you are visiting (see: http://www.embassiesabroad.com with your emergency contact information and submit an emergency contact information sheet to UNC.

UNC Student Health Services (http://studenthealth.unc.edu/medservices/specialty_services/travel.html ) or 966-6573 has an International Travel Clinic which can help to get all your immunizations and meds up to par for travel. This clinic specializes in getting students prepared for going abroad. The appointment consists of a presentation on health precautions, a handout packet on your country of travel and other travel tips, and their recommendations for immunizations and other medications that you'll need prior to leaving. A summary of this process and some alternatives is covered in our document on International Travel Clinic Info.

Call for an appointment 3-6 months prior to travel, or as soon as you know your plans. It takes advanced planning to get fully vaccinated. There can be substantial cost savings when certain vaccines are started early. (You are not required to use their services-you can be immunized at any clinic of your preference but it is likely that student health services will be considerably less expensive than private travel clinics or physician offices). The appointment for the clinic itself may cost a bit more than a normal appointment with student health. Check the CDC website for recommended immunizations and travel tips for your country. You should also take care of any dental care you need prior to leaving, as well as make sure you have an adequate supply of any prescription and over the counter medicines for the duration of your trip.  Its also a good idea to communicate with those you'll be working with about medical supplies it might be helpful to bring - for yourself or the project. If you are taking any significant piece of equipment, make certain that you know about any customs regulations or taxes that may be involved. MedWorld (a supplier of health supplies and equipment abroad based at UNC) may be able to help you with specific needs. 

Although there are always inherent risks with international travel, we want to do everything possible to prepare students to have safe and enjoyable experiences and we also want to be certain that you have the information needed to respond to an emergency if need be. and to be prepared for emergencies. UNC SOM students and faculty must abide by UNC travel policies and emergency procedures. See UNC SOM Emergency Plan for important emergency planning information.

PLEASE PRINT OUT THIS INFORMATION TO TAKE WITH YOU.  YOU SHOULD ALSO GIVE A COPY TO A CLOSE FAMILY MEMBER STAYING IN THE USA ALONG WITH YOUR PASSPORT INFORMATION, ITINERARY FOR TRAVEL AND EMERGENCY CONTACT INFORMATION

Step 7. Remember to leave some time and energy to re-enter gently and wrap things up when you return

If you have applied for elective credit, you will need to submit an evaluation of your elective, a preceptor’s evaluation of your performance and experience, and whatever project or paper is required by your faculty advisor for the specific class you registered for. The elective evaluation and the preceptor evaluation should be submitted electronically to the Office of International Activities. Your faculty advisor will complete your grade on the One-45 system when all paperwork is complete.

Lydia Efird, Peru 2007

Checklist: Before you Go

• Have you gone to see the travel nurse for the necessary innoculations, etc.?

• Will you need a Visa for the country you are going to?

• Have you checked out the State Department warning for your country?

• Have you filled out the travel insurance forms?

• If you are doing research, have you started the IRB process?

• Have you checked out the Centers for Disease Control's advice on medications, safe travel tips and immunizations for the country you are going to?

Below are some more resources to help you get organized and prepared:

• The GHEC Guidebook: Advising Medical Students and Residents for International Health Experiences:

• "Professionalism 101," by Jacqui Shaw, Child Family Health International Team Alumna. An article on professional conduct during an international project:

• These are informative sites to help you learn about your destination, as well as health considerations while living there.

• The CIA World Fact Book
• Travel Health Online
• WHO International Travel and Health
• National and Religious Holidays
• UNC Student Health's Traveler's Diarrhea handout

• If you plan to take your laptop with you, be sure to find out about accessibility and adaptability. Research the legal issues regarding taking a laptop into the country. It may be more hassle than it's worth. Information on customs and immigration can be found in travel guide books.

Books and Handbooks that may be useful:

Directory of International Grants and Fellowships in the Health Sciences, NIH.

Directory of International Reproductive Health Opportunities for Medical Students, ARHP, 2005.

How to Find and Select an International Medical Elective, S. Huffman, 2002.

The IHMEC Guidebook: Advising Medical Students and Residents for International Health Experiences, IHMEC, 2000.

International Health: A Manual for Advisers and Students, Society of Teachers of Family Medicine, (on-line version), 2000.

Preparing for your Medical Elective Overseas, Christian Medical Fellowship, London, 2004

Provider's Handbooks on Culturally Competent Care (Kaiser Permanente)

A Student's Guide to International Health & Funding Guide, AMSA, 1993.

Where There is No Doctor, D. Werner, C. Thuman, J. Hesperian Foundation.

Much of the material on this page was adapted from the AMSA site on global electives. We would like to thank them for this information.