Golden Rules for your Medicine Abroad

Visiting a different country and a different culture might be challenging by itself. If you are planning on staying for a long period, you should definitely make sure that you don’t leave loose ends which may be difficult to solve once you are in a foreign country. Even more, if you already have a medical condition, different questions might arise. The first one could be: Should I even try? Will it be possible to continue the treatment I’m taking abroad? The quick answer, in most cases, is YES, there are plenty of treatments.

However, not all countries have exactly the same kind of treatments available, so you should do some research prior to travelling.

It is better to spend some time making sure that you will be able to continue taking your medication than arrive in the country and find out that they don’t have your medication and that the alternatives are either more expensive or have a different profile of side effects.

Having a medical condition or a mental problem shouldn’t, by itself, prevent you from deciding to live the experience of living abroad.

Nevertheless, culture shock, different schedules and time differences, lack of familiar and social support and the language barrier can be disturbing and might hamper the adjustment process. Culture shock is defined as “psychological disorientation that most people experience when living in a culture markedly different from one’s own. Culture shock occurs when our cultural clues, the signs and symbols which guide social interaction, are stripped away”( Steger Center 2015- Virginia Tech), increasing levels of anxiety and triggering a different kind of feelings like homesickness, boredom, isolation or compulsive eating and drinking.

Other types of thoughts like stereotyping host nationals and showing hostility towards their culture could also appear, hindering adjustment and, in the end, having a negative impact on your whole experience abroad. You could also wonder if the language barrier would be a problem and if it would be easy to find a treating clinician you can communicate within your own mother tongue.  Not only could language be a problem, but also the lack of knowledge of the most important aspects of your origin country’s culture. And what about having a crisis or an emotional meltdown while being abroad? There are many things one should bear in mind before moving to a foreign country. In the end, the most important thing, whether one has a health issue or not, is finding the right professionals to seek help if needed.

When you go for medical treatment abroad, there are some prior arrangements you should consider before travelling.

To begin with, you should find a healthcare provider.

It is a wise idea to explore what mental health facilities and resources are offered in your destination.  If you are diagnosed with an unusual or severe disorder you should make sure that you will be able to obtain the kind of treatment you need at your destination. It would be a good idea to contact the clinic before leaving, setting up the first appointment and maybe introducing yourself to the future treating clinician. He could ask you for clinical reports, or for the possibility of contacting your treating physician. Communication between the doctor abroad and your treating physician is paramount, not only because it will be easier to prevent relapses while being abroad, but also to assemble aftercare when returning home. Think that the doctor abroad will only know you for a few months, while the doctor from your country of origin might have known you for a long time and will be there whenever you return. Make sure that you enable this communication as it will be useful for planning continuity of care after you return back home.

As mentioned before, if you have spare prescribed medication, you should bring it with you. In case you have the prescriptions or any report which states that you are currently on that specific medication, it would be also useful to keep it with you. Beware the time gap between your arrival and the appointment with a doctor abroad so that you don’t run out of medication which can be overwhelming during the adjustment phase.

Specifically speaking about medicines, almost all types of medications can be found in Spain. These include common medications such as:

• Antidepressants (escitalopram, citalopram, paroxetine, fluoxetine, sertraline, venlafaxine, desvenlafaxine, duloxetine, mirtazapine, trazodone, vortioxetine, agomelatine,      bupropion, reboxetine, clomipramine, imipramine…). In Spain, monoamine oxidase inhibiting (MAOI) drugs are not marketed.
• Benzodiazepines
• Antipsychotics (haloperidol, risperidone, olanzapine, aripiprazole, clozapine, asenapine, amisulpride, ziprasidone, paliperidone…). We still don’t have lurasidone.
• Mood stabilizers (Lithium, valproic acid, carmabazepine, lamotrigine, oxcarbazepine…)
• Stimulants (metilfenidate, lisdexanfetamine…).  In Spain, we don’t have Adderall.

For other specific treatments, you should consult.

Knowing that you have just landed in a different country but have an appointment with a professional who will aid you through your time abroad is immensely reassuring. From there on, you will be able to set further appointments for follow-up, depending on your personal needs. Therefore, you will be able to take advantage of the experience of being abroad, with the certainty that there will be a team of professionals taking care of your health needs. Take into consideration that follow-up appointments tend to take less time than the first one, but still enough to check up on your status. Follow-up appointments are usually used to give an update on your situation to your clinician. He or she will check on side effects, the effectiveness of the medication, symptoms you are still experiencing and will also want to know about your social and work circumstances, with the purpose of making sure that you are doing well in a different country.

You should also check for symptoms you might be experiencing. Some of them could be new while others could be well known. Either way, you should let your clinician know. He will guide you through the process of understanding what’s happening and find the best solution.

So far, so good, but all of a sudden, things might begin to change.

• Insomnia with a functional impact
• Tendency to isolate/social withdrawal
• Homesickness with an excessive intensity
• Inability to cope with daily frustrations
• Poor academic performance

If any of the above appear, you should bring forward your next appointment and tell your clinician immediately before things start to go downhill.

• Clinical reports: This is the means by which two professionals from different countries can establish communication and speak the same language. Not only because of the clinical diagnosis or the current treatment but because clinical reports also include subtle descriptions of the person’s condition which may describe psychological, medical or situational underpinnings of their disease.

• Blood tests: It may be sometimes difficult to get a quick blood test in a different country, so it would be very useful and helpful to bring a copy of your latest blood tests. Not to mention if you are taking medication that needs to be monitored in the blood, such as, lithium or valproic acid. If you are, for example, taking a specific dose of these mood stabilizers but don’t know their blood level and you start experiencing a relapse it will be impossible to tell if it is due to medication or other situations, making it more difficult for the doctor to intervene correctly in the precise moment.

• Medication: As stated before, if you have spare medication, you can bring it with you, making sure that you never run out of it before a doctor can prescribe it.

• Anything else you might consider to be useful

“I think that I might be having a relapse, what should I do?”

 Relapses should always be evaluated by a physician. He will carry out a comprehensive assessment of your current status and ideally will contact with your treating clinician. If he considers that your condition might need urgent treatment, he will refer you to the Emergency Department of an English speaking Hospital. If on the contrary considers that you might benefit from other kind of treatment he will be able to taper off your usual medication and start with a new one.

“I’m feeling homesick. Shouldn’t I be returning home?”

 Cultural adaptation has different phases and each person needs their own time. When the culture shock sets in, feelings of confusion and frustration appear. This can lead to anxiety and depressive symptoms and feelings of homesickness. However, don’t panic. This only means that the adaptation process just started. One is free to decide to return home whenever they want, but this important decision shouldn’t be taken under anxiety/depression.

“I’m not used to drinking as much at home as I’m doing abroad. Could this be a problem?”

Drinking is a social act. The attitude towards drinking can vary widely between countries and regions. In some cities it might be more accepted or culturally normal than others. However, this shouldn’t be misleading. Only you know if you are drinking compulsively. Only you know the effects alcohol has in your body. And only you know that if you are on medication, you shouldn’t be drinking huge amounts of alcohol. If this becomes a problem affecting other areas of your life, like relationships or college, then you should discuss this issue with the doctor.

“I don’t know if I should tell other people about my condition.”

 When being abroad, one gets to know a lot of people. Some will become close, others won’t, but in the end it is very important that you manage the information about your own condition wisely. This means that you shouldn’t be sharing it with everybody you’ve just met, but finding people you can trust and rely on to tell them instead.

“I think that I might be having a relapse, what should I do?”

 Relapses should always be evaluated by a physician. He will carry out a comprehensive assessment of your current status and ideally will contact with your treating clinician. If he considers that your condition might need urgent treatment, he will refer you to the Emergency Department of an English speaking Hospital. If on the contrary considers that you might benefit from other kind of treatment he will be able to taper off your usual medication and start with a new one.

“I’m feeling homesick. Shouldn’t I be returning home?”

 Cultural adaptation has different phases and each person needs their own time. When the culture shock sets in, feelings of confusion and frustration appear. This can lead to anxiety and depressive symptoms and feelings of homesickness. However, don’t panic. This only means that the adaptation process just started. One is free to decide to return home whenever they want, but this important decision shouldn’t be taken under anxiety/depression.

“I’m not used to drinking as much at home as I’m doing abroad. Could this be a problem?”

Do you have a question I didn’t cover?– Feel free to ask anything that you might be doubtful about before you leave. There is an extensive network of professionals who will be willing to help you make your time abroad an incredible experience.