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					  Checklists for International Health Electives                                  (With Explanations)

1. Deciding whether to do an elective:
         A. Time Frame:

               How long an elective?
When you travel overseas you need more time to adjust to the new culture, language and environment.
Four weeks might be a long elective in Canada, but on international electives, four weeks is probably the
absolute minimum time period. Planning a six-week elective will give you the best opportunity to learn
about the culture and people of your destination, but of course, six weeks is a big investment of time.

               When in medical school is best?
The summer between second year and third year may seem appealing because of the 14-week summer
holiday, but we often don‟t have the basic clinical skills needed to benefit maximally from an overseas
experience. Having core rotations under your belt can make international elective work more rewarding.

               What about CaRMS/Match day?
CaRMS interview-time is bad time to be in Tanzania doing international electives. Things are changing
with the advent of e-CaRMS, but nonetheless, you‟ll want to discuss this issue with your UofA preceptor
before setting dates for your elective.

               How much time needed to adjust to the new setting?
Depending on your personality, the destination country and the host-site, you‟ll need at least one-to-two
weeks to acclimatize to the new location. Some students arrive one week before their elective starts so they
get used to the environment before starting the elective.

               Do you need time before/after to visit or travel?
If part of your motivation for traveling overseas includes visiting another country, protect some time in
your schedule for traveling and visiting the country.

         B. Other Considerations:
               Identifying a preceptor at the UofA.
This is quite possibly the most important step in international health elective preparation. The person you
choose should be experienced in advising students for international travel and willing to spend time with
you to develop a safe, effective elective. You should talk to different people about the specifics of your
elective and then bounce the ideas off your preceptor ensuring you get a wide spectrum of viewpoints.

               Funding?
There are some scholarships available for international medical electives. Church groups, Non-
Governmental organizations and the Canadian International Development agency might have funds
available for international health work as well. Students have gone to local cultural groups for fundraising
as well (for example, the if you were going to Bangladesh, you might approach the Bangladesh-Canada
association). Having a budget with expected costs is useful since people often want to know how much
they‟ll have to donate. Sometimes people are reluctant to donate $50, but willing to buy your round-trip
plane ticket because they are buying something concrete.

                 Allergies or other health issues that hinder travel to particular sites?

               Is a ‘significant’ other involved?
International electives may seem like a great opportunity to travel with a partner. Remember to consider
this when setting your goals and your time frame. Carefully consider your motivations and discuss these
issues with your preceptor to determine if an international elective is in the best interests of your
relationship and your medical career.

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               Planning for unforeseen family emergencies
Many things can happen in the 6-18 months it takes to prepare for an international elective. Your brother
might get into a car accident; your wife might get pregnant or whatever. You should devise a contingency
plan for the unforeseen if needed.

2. Setting up the elective

         A. Planning Decisions
               supervising faculty in host country
You have to identify a person who will act as a preceptor in your destination country. Talk to students who
previously traveled to the site or to talk to your preceptor in Edmonton to identify good clinical teachers
who will help you learn the most from your overseas experience. Many people would say that the
preceptor is a more important consideration than the location. You will learn a lot from a good teacher
regardless of whether you are in Tanzania or Sudan.

               location/site
There are many factors to consider when deciding on a location for your international elective. What types
of health problems do you want to see? Do you want to work in a big-city hospital or a rural clinic? Have
students traveled to the site previously? How easy is travel in the destination country? How safe is the
destination country?

              Demographics of population that you wish to work with
Rural or urban? Geriatric, adult, pediatric? Affluent, middle-class or impoverished? Etc.

             Types of diseases/problems you wish to see
Are you looking for tropical infectious diseases? Trauma care in areas with few resources? Well-baby
clinics? What are you looking to see and do?

               medical specialty area
Infectious diseases, emergency medicine, and population health tend to be popular areas for international
health electives. Pediatrics, Obs/Gyn and others are also quite popular as well.

         B. Letter of Agreement between host site and student
You‟ll want a letter that outlines exactly what is expected of you, the student as well as what is expected of
the host site. You might change the conditions outlined in the letter once you arrive on-site, but at least
you‟ll have some idea of what to expect. Try to reduce the unknown as much as possible.

             Dates of elective
When will you arrive? When will you start? When will you finish? When will you depart?

               Plan to meet student on arrival
Who will meet you? How will you get from the airport to your accomodations? Can you email each other
pictures or will you wear a purple baseball cap and your host will wear a yellow top hat?

               Accommodations
Where will you stay for the duration of your trip? Is it possible to pay for the accommodations before
arrival so you don‟t have to carry as much cash? What contingency plans are available if the
accommodations are unacceptable for some reason?

              Food issues
Any religious or dietary restrictions? Allergies? How will you deal with food safety issues?



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             Work site and facilities
What resource limitations can you expect to face? Is there a regular supply of water? Electricity? Gas?
How well-stocked is the pharmacy?

              Local health care for student
For minor health problems do you have access to sutures or antibiotics? If you have to pay for these
services, how much does it cost? For major health problems, you‟ll want to think about how you can
evacuate back to Canada.

               How can the student be contacted
Phone numbers, email access, fax? Also, check out where the local poste-restante is. A poste-restante is
designed for travelers to pick-up mail. For a small fee the office will hold the mail and then you can come
by once a week or once a month or whenever, pay a small fee per item and retrieve your mail. Make sure
you take a passport for photo ID.

               How will student be evaluated?
Both your preceptor in Edmonton as well as you preceptor overseas should evaluate you based on the
things they are able to evaluate. You can design an evaluation form with your UofA preceptor which is
based on your learning objectives. The faculty of medicine also has a standard evaluation form that has to
be completed for all electives. You‟ll want to get these forms filled out while you are overseas and bring
them back yourself. Otherwise, paperwork gets lost, busy preceptors get busier and you are left with a ton
of headaches

               How will the host site be evaluated?
There are standard forms that can be used to evaluate the host site. Remember that future students may
want to travel to the same place so your evaluation form can be invaluable. Future students can use your
contacts and develop on the things you did overseas.

         C. Logistical Details
              Passport
Application forms are available from any postal outlet as well as Canada Place downtown. If you have
questions about the form, try http://www.dfait-maeci.gc.ca/passport/menu.asp There is also a 1-800
number, but the voice mailbox system is a complete nightmare. If you can‟t find your answers on the
website, you can go to the passport office at Canada Place (160-9700 Jasper Avenue) where you can talk to
someone in person. There are usually a lot of people waiting in line, but it is still faster than the phone.

Canadian passports have undergone changes to make them more secure in the post-September-11th world.
At the time of writing, the passport fee was $85. In general the passport is ready in 10 working days (ie:
two weeks). You can pay an extra $30 to have your application expedited and ready in 2-9 working days.
Or you can really grease the passport office‟s palm and drop $70 extra to get your passport the next day.

If you already have a passport, you must ensure that the passport is valid for 6 months after you return
from your destination. Many countries will forbid entrance if your passport expires within six months of
your expected return date.

              Entry Visa
Many countries require an entry visa for Canadian citizens. Usually you have to submit an application
form, photographs and an application fee to the country‟s embassy or consulate office. Depending on the
country and the mood of the people in the office, the visa can take one day to one month. If you are
mailing your passport (most countries only have embassies in Ottawa), you will likely have to send a self-
addressed-stamped-envelope so the embassy can mail the passport back to you. Most people use a courier
service because they want to track their passport in case it gets lost.

For a list of embassies in Canada, check out www.embassyworld.com or
www.usask.ca/sas/isao/country/embassy.html

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               Vaccinations
Set up a travel clinic appointment about 6 weeks before you intend to travel. Specially trained physicians
will give you up-to-date health information about your destination country and will advise you of the
recommended vaccinations. Travel Clinic visits are not covered by Alberta Health, and cost about $40
(2002). Most vaccinations for international travel are also not covered by health plans and several
vaccinations are quite expensive. And you thought those pizza lunches sponsored by pharmaceutical
companies were free!

               Travel insurance
If you have to cancel your trip for some reason, trip cancellation insurance will reimburse the cost of your
plane ticket and perhaps other costs. Be careful because there are often many legal-ese clauses that exist in
these documents. For example, some insurance only covers cancellations for compassionate reasons (death
or significant illness in the family). So, for example, if you cancel because a war breaks out in your
destination country, the insurance won‟t cover it. Also, sometimes your credit card will cover trip
cancellations as long as you pay for your plane ticket with the card.

               Health insurance
Getting sick overseas can be a disaster. Many companies offer travel insurance, all of which have different
clauses and costs. Things to look for are how will the hospital be paid (direct billing or does the insurance
company reimburse you after you paid?), do you have evacuation insurance if you get very sick and need to
be returned to Canada immediately?.

              Licensure/Malpractice insurance
Check with your host about whether you need malpractise insurance. Many developing nations don‟t have
any provisions for malpractice litigation, so malpractice insurance is a non-concept. Obviously, being on
the Royal College register only gives you protection within Canada.

              Keeping a diary
Diary writing can be very therapeutic and allows you to go back and remember much more about your
experience overseas when you return. It takes some dedication, but will make things much easier when you
want to recount anecdotes and stories. A small note, try to record personal data about the people you meet:
Get their name, the age, their gender, their occupation etc. Saying, “John Adams is a 32-year-old carpenter
from Johannesburg. I met him on July 25 th, when he came into the clinic complaining of a „small‟ stomach
ache.” Is much more engaging than saying, “Then this big guy came into our clinic with a branch hanging
out his stomach…”

               Make a health information card
If you get into an accident or are incapacitated for some reason, ambulances and hospitals will be able to
get the info
                         Name
                         Address
                         Emergency contact names/phone numbers in the host country and in Canada
                         any pre-existing medical conditions
                         allergies
                         current vaccination status
                         blood type
                         current medications
                         eye glass prescriptions
                         other pertinent information.

               Fallback/Contingency Plans – Accommodations
What will you do if the accommodations are unavailable because of a flood or some other chance reason?
Is affordable housing available at local motels or hotels, until a suitable arrangement is made?




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              Fallback/Contingency Plans – Food issues
What can you do if you are unable to eat the food because of allergies or some reason? Can you get
healthy food to cook yourself?

               Fallback/Contingency Plans - If the elective is not going well
Although this is probably a rare situation, it is a good idea to have a contingency plan just in case. What if
your on-site preceptor is making unwelcome advances? What if you are only dealing wealthy patients who
come to the clinic with western-type pathology when you were hoping to see patients dealing with diseases
of the poor? Can you contact your UofA supervisor and ask for advice? Who else in the destination
country can help you?

               Fallback/Contingency Plans - If your health/safety is at risk
If an unexpected hurricane is set to hit your city will you be able to find suitable shelter? How can you get
into contact with the nearest Canadian High Commission office if you have to evacuate the country?

3. Things to take with you
                 Passport*
                 Photo ID*
                 Student ID*
                 Itinerary*
                 Reservation/confirmation numbers*
                 Insurance Cards*
                 Credit Cards* (Depending on the destination)
                 Cash (Local Currency and US dollars or Canadian dollars depending on the destination)
                 Travellers’ Cheques*
                 Toiletries (Soap, Shampoo, Menstrual Products, sunscreen, Toothbrush, floss, etc)
                 Extra Pair of glasses (in case you lose your original ones)
                 Clothes (remember to check the weather/season in the destination…a raincoat in some
                  places can make a huge difference)
                 Proper shoes (You want to be safe and comfortable. For example, flip-flop sandals are
                  comfortable but can be dangerous in places with scorpions.)
                 Medical equipment such as a stethoscope, reflex hammer, otoscope etc
                 Gift/Souvenirs for the people you will meet overseas

         * Items marked with an asterisk should be photocopied. Keep a copy in your checked-in luggage
         in case you loose your carry-on and also leave a copy with someone you trust in Edmonton in case
         you need the info. One dollar in photocopying costs can save you many headaches.

4. Once you arrive in the destination country

            Register with the consulate office of the High Commission in the country. If Canada
             doesn‟t have an office in that country, you might be able to register with the British High
             Commission Office or Australian High Commission office. If there is an emergency in the
             country, the office will know you are in the country and provide some help.

            If you promised your family to call home once you arrived, then do so…don’t cause
             them unnecessary anxiety

            Remember to respect local customs and laws. Your Canadian citizenship provides no
             immunity from local laws.

            Reconfirm any flights for your trip home 48-72 hours before your departure




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5. Once you return Home
           Evaluation of the Host site by student
           Evaluation of elective by student
           Completing an information form for the Electives database
           Evaluation by host site of student
           Evaluation by UofA preceptor of student




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