MEDICAL REALITIES OF DIPLOMATIC AND INTERNATIONAL CAREERS Health considerations for you & your family relocating abroad Dr Franck SCOLA

Health and Expatriation - Specificity - Awareness raising - Cross-culturality - Multidisciplinary approach

Impact of Expatriation on Health - Physical - Social - Psychological

Repercussions on the Quality of Life - Married life - School life - Professional life - Parenthood

Consequences - For the individual - For the workplace - For the family

Various Levels of Environmental Changes - Physical - Cultural - Linguistic - Societal ocial

Sociological evolution New profiles New needs New demands Comtemporary Trends in Expatriation

Management of expatriates Supporting families Health, safety and welfare New Missions

Lifting the Taboo for a more Human Approach

Seeking Medical Care In A Cross-cultural Context Facing the unknown: - Local risks - Variations in health systems - Accessibility to medical care

Seeking Medical Care In A Cross-cultural Context Consequences from problems accessing medical care: - Non-treatment - Neglecting preventive health measures - Inappropriate medical care

Aggravating factors of medical risks : - Unpreparedness of key players - Lack of training for care-givers - Risks connected with social networking - Lack of information for patients Seeking Medical Care In A Cross-cultural Context

 Being ill far from Home  Discovering the host country’s health system  Patient and caregiver from different cultures  Language barrier Cross-cultural Issues In Medical Care

Anticipating measures of:  Information  Prevention  Medical assistance in case of emergency  Evaluating specific health risks for each family member Goals for HR Departments

For the: Expatriate employee Accompagnying spouse Children What kind of medical follow up ? Evaluating medical needs of each family member

Change of status + Change of environment Risks (disease, accident, pregnancy, disability…) Difficulty in accessing medical care + Inappropriate trends in health behavior + Risks connected with social networks Medical And Social Specificity In Expatriate Life Vulnerability Aggravating factors

Physical Health Polymorphous symptoms Variability of clinical expression No specific organ affected

Physical Health Specific mechanisms:  Occurrence of troubles  Evolution

Physical Health Aggravating factors depending on:  Patient’s reaction: reluctance, procrastination, panic  Information: availibility and validity  Cultural and linguistic factors  Healthcare facility: cross cultural competences

Mental Health  Symptomatic expression  Variability  Mechanisms

Mental Health  Predisposed profiles  State of vulnerability  Migratory trauma

Mental Health  Unrecognized suffering  Difficulty to speak  Isolation  Finding an understanding ear

The Accompanying Spouse  Change of status  New challenges  Vulnerability

The Accompanying Spouse  Impact on family life  Married life  Parenthood  Aggravating factors

The Children  Status of follower  Influence of mother’s condition  Pediatric follow-up  Early bilingualism

Mastery Adaptation Disillusion Culture Shock Honeymoon Months passed in the foreign culture Moral/ Confort psychologique Morale/ Psychological comfort La théorie de la courbe en U d’après Black et Mendenhall (1991) d’après Black et Mendenhall (1991)

27 Cycles Of Adaptation 6. Acceptation of host culture 7. Anxiety of repatriation 8. Reverse culture shock 9. Reintegration Adaptation Stages Emotions and Energy 1. Initial anxiety 2. Honeymoon period 3. Initial culture shock 4. Disillusion 5. Adaptation process Country of origin LOWLOW Country of origin Host country HIGHHIGH Reverse culture shock Reintegration Honeymoon period Honeymoon period Strangeness of others’ behaviour Behaviour does not get expected results Unreadiness for environmental pressures Gradual adaptation and integration to the host culture 1 xa

28 Cycles Of Adaptation 6. Acceptation of host culture 7. Anxiety of repatriation 8. Reverse culture shock 9. Reintegration Adaptation Stages Emotions and Energy 1. Initial anxiety 2. Honeymoon period 3. Initial culture shock 4. Disillusion 5. Adaptation process Country of origin LOWLOW Country of origin Host country HIGHHIGH Reverse Culture scock Reintegration Preparation Intercultural training and coaching Language lessons Expatriate Support programme (ESP) Domestic ESP repatriation services Services in destination country

 Before departure: selection & preparation (training on the country, culture, personal & family variables);  On arrival: continued support in the field (language training, coaching, programme of expat aid, destination services);  Repatriation: reintegration (return training, integration to the department & the work team, support). Support for Expatriat Workers Three critical times for intervention

Transferring a problem colleague Career burnout Excessive technical qualifications Family problems Culture shock WHY!? Source: Gomez-Mejia et al., p. 508, (2000) Expatriation Sometimes Fails Ineffective training

Identity Strategy Conservatives Defensives Converted Opportunists Transnationals

Behaviour In Seeking Medical Care Conservatives Defensives Converted Opportunistics Transnationals

Key words : Specificity Vulnerability Cross-cultural Issues Anticipation… Have A Healthy Stay Abroad