It can be extremely stressful when we, or someone we love, becomes ill abroad. As well as the (very normal) physical and mental turmoil of illness, we often find ourselves dealing with additional challenges that are unique to international life.
Participants included missionaries, financial planners, educators, executives, researchers, writers, coaches, artists, and others within the international community. They were also parents of children with serious medical conditions, spouses to partners with a serious illness, or medical patients themselves.
Swiss, Canadian, Italian, Austrian, Australian, English, Israeli, American, African, Belgian, Taiwanese, and Dutch passport holders have all contributed to this ongoing discussion.
In Part I of this article, we discussed the interplay of the following eight challenges when facing a health condition abroad: Lack of Knowledge, Financial Impact, Isolation, Communication, Mistrust of Medical Personnel, Overwhelm and Indecision, Complex Parenting, and Pain and Discomfort
In Part II, we share four overarching strategies that experienced expats have utilized in their own healthcare journeys abroad: Being Proactive, Practicing Mindfulness, Cultivating Fun, and Connecting with Others.
The advice and insights to follow come from those who have chosen to see their health challenges abroad as opportunities for growth and vital enrichment. Their experiences, though sometimes excruciating, have opened the doors to love, self-reliance, relief, personal empowerment, creativity, confidence and inner strength.
Imagine a tool-belt loaded with the strategies below. Choose what fits for you. Be curious, explore, and remember that like with any new skill, we become more proficient with planning, commitment, practice, and a connection to why we’re doing it in the first place.
1. Be Proactive
Expats who take peremptory action against potential problems when it comes to healthcare say this is the foundation to their success. Not every situation can be controlled, but they urge others to identify the things for which they can prepare. Research and learn the logistics of the medical system, they say. Don’t make assumptions, nurture your inner leader, and take care of yourself, so you aren't left reacting to a situation with limited tools within reach.
Patrice "Pattie" Schweitzer reminds us that part of being proactive is being careful not to make assumptions. For example, Pattie has managed her complex healthcare needs across eight nations, over a span of 34 years. She's learned from experience that different countries have different regulations for medications. While one country may require a prescription for a given medication, another sells it over the counter. Or, as Pattie experienced, a prescribed medication in one country could be classified as an illegal substance in another.
She urges others to plan with their physicians well before their travel date to identify alternative medications or to adjust their treatment plan based upon regulations in their destination country.
Other assumptions about treatment protocol, hospital services, or payment options can lead to unnecessary stress. Whenever we assume we know something, based upon our former experiences in other countries, we set ourselves up.
Embrace Your Inner Leader
Looking back, those patients who describe a real sense of personal power and satisfaction around how they coped with their healthcare challenges are those who also claimed some authority over their own bodies and medical history. They’ve honed in on their intercultural communication skills, persisted if dismissed, got creative, and kept searching for a physician who shared their values.
For parents of young patients, having confidence in their unique knowledge of their child’s medical history, temperament, personality, and coping style is vital when crossing cultures.
One mom talks about crossing four different borders with her son's medical condition. She became a pro at choosing healthcare providers and coordinating services across cultures. She explains how clarity and cohesion around their parenting values, helped she and her husband build a strong sense of leadership around the medical care of their son.
Pattie shares how she crossed five borders with an auto-immune condition and came across a wide variation of communication styles and beliefs around treatment protocols. At a certain point, she says she had no qualms "firing" a doctor who did not value, or respect her personal experience living with the illness. As the only constant in her health care across borders, she makes sure to keep hard copies of all her medical records, sharing only copies with new physicians.
Aside from good nutrition, adequate sleep, and basic hygiene, the definition of self-care is personal. It doesn't have to mean three days at a spa or a weekend away. It can mean meditating in the hospital chair as a loved-one sleeps, walking laps around the hospital, regular visits to a space set aside for prayer or contemplation, or stepping outside for five minutes to breathe fresh air.
One partner explains how she searched for a peaceful, light-filled place in the hospital where she could take 10 minutes to restore once or twice a day during her husband's long hospitalization. Another partner etched out time to practice yoga between hospital visits, working, and household tasks.
An expat having gone through chemotherapy in Qatar explains how much better she felt when donning beautiful head wraps, jewelry, make-up and having her nails done, even if she was feeling physically terrible.
Along with self-care, many parents of kids with complex healthcare needs, talk about the importance of “couple-care”. Finding a way to take time to be with each other is a real challenge when living abroad with a medically complex child.
When Alessandra Giocometti's toddler experienced an unexplained respiratory disorder while they were living in The Netherlands, she and her husband benefited greatly from the "rucksack" program that provides a stipend to families with children with complex medical needs. The stipend pays for home-nursing and medical child care, so that parents can take time to connect outside of the home, or participate in activities that are rejuvenating.
Self-care begins with acknowledging that it’s a basic need and making it a priority. The “how” comes later.
Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us. Mindfulness teacher Jon Kabat-Zinn calls it “a love affair with life.”
The ability to pay attention, on purpose, in the present moment and without judgement is vital to making the shift from seeing a situation as unmanageable, to seeing it as filled with new opportunities to live more deeply.
Stay in the Present
Staying in the now prevents our brains from racing forward into the blackhole of 'what ifs'. When Jodi Harris’ young son experienced life-threatening symptoms of type I diabetes in Madagascar, a firm foundation in meditation and mindfulness practice got her through the initial chaos of her son's diagnosis (including an emergency evacuation from their home of 18 months).
Because she’d been developing these skills over time, she was able to apply them immediately. Jodi believes this was the fundamental factor to her ability to stay level-headed and reliable throughout his near-death experience and recovery.
Pattie, too, after multiple, serious medical encounters and years living abroad with fibromyalgia and asthma, named her most effective coping strategy as “focusing on the present moment.”
Feel and Acknowledge ALL Emotions
After losing part of his leg due to what was thought to be a bacterial infection, one participant stresses the healing that experienced when he allowed himself to feel and express his sadness, grief, and regret. Another who waited three long weeks for biopsy results, stressed the importance of talking about one’s fear rather than sitting on it letting it fester and grow.
Jodi, too, says that permitting her fear, sadness, and sense of loss to flow through her body in real time, allowed her to stay present and be an effective parent for her son during his recovery.
Several parents talk about the discomfort of living in limbo without a diagnosis for their child and spending years wondering if they'd done something to cause their child's developmental difficulties. One mother recalls her feelings of guilt and self-blame for what had happened to her child.
"What did I do wrong?" she wondered, only to find out years later that his developmental struggles were unpreventable due to a genetic condition. Allowing herself to release that old guilt has allowed her to be more present for herself and her family today.
Another participant shares that acknowledging her own depression and expressing her feelings to others in similar circumstances, allowed her to receive the support she needed so she could move through depression in a healthy way with an experienced counselor.
Words carry energy. Notice how words influence feelings, for example. When we use words that lift us up and resonate within us deeply, we feel more powerful. The opposite is also true.
Some chose to call themselves a “survivor”, rather than a “patient” or “victim of…”. Others kept their illness and their personal identify completely separate. For example, one woman explains how she made a point not to identify herself as a cancer patient or survivor. She chose not to wear pink, wear a ribbon, or join in cancer-awareness activities. From her perspective, she was treating a temporary illness and did not invite it to become part of her identity.
When asked about inner strengths, participants used words and phrases like "born a fighter", persistence, and grit. Mantras like “quiet the mind to save the body”, and healing imagery like being wrapped in a “blanket of love”, rainbows after rain, light shining out of darkness, and a phoenix rising out of the ash helped partners and patients alike to feel more powerful or safe.
When asked to name his healthcare journey, like a chapter in a much larger tale, a story of vulnerability, broken bones, and surgery while on vacation in Spain became A Spanish Tumble. For the years she zigzagged across the world trying to navigate a wide range of medical systems, Pattie’s journey became The World Maze of Healthcare. Giving it a name creates distance, so that a person can look at their situation from the outside and realize that they are not the illness or injury.
Focusing on what is going right creates an energetic shift for many people. Some use a gratitude journal to record the little and grand aspects of their daily lives, incorporate their thanks into their daily prayers or into an intention they set for the day. Others in the group make the effort to give direct thanks to the people or organizations that helped and supported them through their medical ordeal.
Those who feel like they are living more profoundly with a greater sense of connection to others and life itself, have taken the time to reflect on their healthcare journey and their own strengths and vulnerabilities. We all have a dominant personal coping style, an Energetic Profile and an Energetic Stress Response.
Understanding how the human stress response works and how we, or our loved-one, cope under stress provides the opportunity to make stress work for us, instead of against us. Once we understand what triggers our stress, we can work to transform it.
3. Cultivate Fun
Adults benefit from play just as much as children do. Not only is there therapeutic value in creativity and recreation but the diversionary aspect of play reduces stress, induces the relaxation response, and often provides avenues for connecting with others. Research also tells us laughter and smiling have direct health benefits and actually change our brain chemistry.
For some, long waits in the treatment room, during dialysis, or chemo treatments become opportunities to practice a skill, create, or lighten the mood for others.
One participant knits through her chemotherapy treatments. She uses photography to create self-portraits with a humorous slant, like a shiny green apple juxtaposed against her shiny pink scalp. She spends time with a group of women who share her sense of humor.
Another describes his own mischief-making during a long and isolating hospitalization. Using meditation techniques to slow his heart rate he was able to set off monitor alarms, causing his nurses to come running.
Discussion participant, Cath Brew, author and illustrator of Living Elsewhere, draws cartoons with often humorous and sometimes poignant captions about the experience of living abroad. She sees the lightness in the shadow side of being a global nomad and has found a way to heal and expand her own support system using creativity and humor.
4. Connect (and Accept Support)
Feeling isolated and alone is one of the most frequently mentioned challenges expats describe when facing a health crisis abroad. Far from family and close friends, some described their hesitancy to cross professional boundaries by informing colleagues of their situation or asking for assistance.
Several participants who were working abroad and single, expressed the loneliness they experienced and how much they appreciated the help their colleagues provided. No one seemed to regret that they’d finally reached out and accepted help from acquaintances.
For these expats, little things like hospital visits or telephone calls from colleagues, and larger gestures like retrieving fresh clothes and personal items from the patient’s home, or sitting with a hospitalized child while the parent takes a long overdue immediately broke the sense of aloneness they were experiencing.
Choose Your “Healing Team”
One US Department of Defense civilian employee describes how she created a "protective bubble" for herself while going through cancer treatment in Italy. She discussed her illness only with those who had gone through treatment themselves or those who offered to help in tangible ways. She chose not to talk about the illness at work, allowing her to maintain a much-needed sense of normalcy in that part of her life.
Another expat receiving cancer treatment in Qatar described her "core group" of "succulent women" -- high energy friends who were living life with zeal. This allowed her to stay engaged and inspired.
Use Social Media Consciously
Several participants talked about how social media was both a blessing and a curse, urging others to choose carefully what, and with whom, they share online. It's important to know what purpose social media will serve and use it mindfully. Not everyone on social media knows how to be supportive or empathetic. One person chose to post nothing about her illness and recovery, while another used it for daily support.
Have Faith, Build Trust
Many people with whom we spoke, expressed a sense of complete confidence or trust in something. Be it a higher power, the medical team, a greater purpose, or their own inner strength, turning towards a faith or life philosophy that held meaning and hope carried many through otherwise impossible times.
Eliafra Seror, an American mother of nine living in Israel, says she had a very clear thought in her head after experiencing debilitating rheumatoid arthritis at the age of 42. "I knew I would find a way out of the pain," she says. “I thought to myself, ‘This is not how my life goes. I will find a way out. No doctor’s going to dictate how life will be.’” She was nursing a one month old, had seven other children and couldn’t dress herself, but immediately began researching diet changes and natural treatments.
Some talk about prayer being the backbone of their recovery, imagining themselves in the "palm of God's hand" or "being healed by God's light," as Eliafra describes.
Many talk about how important it is to build trust with their physicians. When parents are considered part of the team, trust immediately increases. One Italian mother describes an evening when she and her husband host their son's neurologist in their home for dinner while living in The Netherlands. Though unorthodox to some, this was a turning point in their relationship, she says.
To friends, to help, to love. "Say YES!" exclaims Jodi Harris. When her young son required hospitalization and a medevac out of country, she accepted whatever help she and her family were offered, acknowledging their gestures of love directly, making her gratitude known. It’s not the time to pull away or let complex feelings get in the way of accepting support. Allow any outpouring of love to carry you through.
Make a Difference for Others
For many, the opportunity to turn a painful, frightening, difficult path into something more meaningful comes to those who find value in sharing their experience, support, and wisdom with others who are facing similar challenges. Acting as a mentor to someone new to the situation is an opportunity to give others a chance to “say yes,” connect, and build trust.
Some choose to work toward making systemic change in the areas they felt were lacking within their own experience. One former patient, is taking part in a medical school reform project called Patient as Teacher in Qatar. Here, she and other former patients provide education about the patient experience for young medical students and doctors.
We invite you to join our discussion by sharing your own tools and strategies for thriving through health challenges abroad. What unexpected opportunities have emerged from your healthcare challenges?
What would you add to this list? What insights do you have for those facing a life-shifting health experience abroad? Let’s share our tips and support each other!
If you are considering seeking professional support, working with a professional coach or psychologist creates a safe place to express your thoughts and feelings, create solutions, make decisions, and feel more satisfaction, peace, joy, and vitality in your life.
A Certified Child Life Specialist can support you and your child or teen in preparing for an upcoming medical event, developing and rehearsing a coping plan, providing psychological preparation, and education around a child's understanding and experience of illness and loss.
Many thanks to the 2018 Families in Global Transition Kitchen Table Conversation participants and other interviewees who have shared their stories and insights with us over the past eighteen months. You are all inspirational leaders in life and the expat community at large. Namaste.