MEDICAL REALITIES OF DIPLOMATIC AND

INTERNATIONAL CAREERS

Health considerations for you & your family relocating abroadDr 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

- Social

• 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 ofeach 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

0

1

2

3

4

5

6

7

0-2 3-4 4-6 6-9 10-12 13-24 25-36 46-48 49+

Mastery

AdaptationDisillusion

Culture Shock

Honeymoon

Months passed in the foreign culture

Mor

al/ C

onfo

rt p

sych

olog

iqu

e M

oral

e/ P

sych

olo

gic

al

com

fort

La théorie de la courbe en U d’après Black et Mendenhall (1991)

27

Cycles Of Adaptation

6. Acceptation of host culture7. Anxiety of repatriation8. Reverse culture shock 9. Reintegration

Adaptation Stages

Emotionsand Energy

1. Initial anxiety2. Honeymoon period3. Initial culture shock4. Disillusion5. Adaptation process

Country of origin

LOW

Country of origin

Host country

HIGH

Reverse culture shock Reintegration

Honeymoon period

Honeymoon period

Strangeness of others’ behaviourBehaviour does not get expected resultsUnreadiness for environmental pressures

Gradual adaptation and integration to the host culture

1

xa2

3

4

5

67

8

9

28

Cycles Of Adaptation

6. Acceptation of host culture7. Anxiety of repatriation8. Reverse culture shock 9. Reintegration

Adaptation Stages

Emotionsand Energy

1. Initial anxiety2. Honeymoon period3. Initial culture shock4. Disillusion5. Adaptation process

Country of origin

LOW

Country of origin

Host country

HIGH

Reverse Culture scock Reintegration

1

2

3

4

5

67

8

9

PreparationPreparation

Intercultural training and coaching

Intercultural training and coaching

Language lessons

Language lessons

Expatriate Support programme (ESP) Domestic ESPExpatriate Support programme (ESP) Domestic ESP

repatriation services repatriation services

Services in destination

country

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 :SpecificityVulnerabilityCross-cultural IssuesAnticipation…

Have A Healthy Stay Abroad