Tips for students and young professionals embarking on their first international health experience

Guest blogger: Geoffrey Horning

As members of the APHA and specifically as students in the International Health section, none of my colleagues find the thought of living and working overseas all that strange. In fact, they quite often find the thought exciting, intriguing and something they aspire to do. Many of us, myself included, already have work experiences outside of American borders. In this two part posting, I thought I would share a little of the perspective that I have developed as a “westerner” currently working in the Middle East and North Africa.

On November 11th 2011, I boarded the first of three flights from St. Louis Missouri that would ultimately land me in Riyadh, Kingdom of Saudi Arabia. News media, YouTube and the rest of the internet do not do Saudi Arabia justice, but I thought I had some idea of what to expect from my previous travels…I was wrong. Here are some of the things I’ve learned about living in another culture, and especially one completely different from your own.

First Things First: Know your surroundings and be aware of your situation at all times. The last thing I want to do is scare you or encourage you to stay inside. Neither of those things is necessary, and in fact they are both counterproductive. However, it is important for your safety that you remain alert. Failure to do so can make you the target of groups looking to exploit your naivety, whether it be for a simple street hustle, unlicensed taxi ride that keeps getting more expensive, bribes or more nefarious robbery and kidnapping. Always make sure someone knows where you’re going and when you will be back, register with your embassy in the countries you’ll be visiting, and always keep an eye on a possible exit.

Roll with the punches: Nothing is what it seems, you are a foreigner, a stranger in a strange land, and you learn daily. If you crave the stability of familiar things, this is going to be rough. Every time you think you’ve figured something out, it changes, or more likely, you realize you were just wrong about your previous assumptions. When you laugh things off, or regroup and try a different approach, when you finally realize the “punches” aren’t directed at you and in fact are simply cultural differences — then you’ve made it.

Know the Law-BEFORE you arrive: Two of the “silliest” things I see here are people who have no knowledge of the laws, and worse, people who flagrantly violate the laws and then expect a United States Passport to get them out of trouble. This doesn’t work; it understandably annoys the State Department, and reflects poorly on all of us from your home country. Please follow the law of the land.

Know your health status-and respect it: Consider any medical conditions that you have that require specialized treatments and or medication. Do a quick internet search and see what you have to do in order to get those treatments or those prescriptions filled in the host country. Never, stop taking a medication without a doctor’s advice. Items of specific concern are analgesics/painkillers which may be considered illegal narcotics where you’re headed and psychotropic medications that may just not be available. If you have a history of cardiac problems, it would behoove you to look into the state of cardiac care in the country and region you’re going to.

Learn the language: A vast majority of people in Saudi Arabia are already bi or tri-lingual. English, French, and of course Arabic are commonly known. My Arabic is probably best described as “atrocious”, and the Saudi dialect of Arabic can be quite a bit different from Modern Standard Arabic, which is what you’ll usually get from a language program. That being said, I know enough to get around, and it helps. Start working with it from day one. Your supervisors, co-workers, cashiers, waiters, driver and hotel bellman all speak two or three languages; you might want to go ahead and try to catch up. It’s appreciated.

Check your privilege at the customs counter: The idea of “privilege” is a contentious topic in modern day America. However you feel about it, I assure you that it exists. You’ll see it up close as you process through customs and immigration the first time, and you will probably realize that you have more travelling money in your wallet than some of the people in that line make in a month. If a customs officer recognizes that you’re American/Canadian/British (i.e. “Westerner”), he might pull you out of line and take you to the front, bypassing the 100 people in front of you. Don’t argue with this man – but don’t act like you deserve it. If you’ve been recruited as I was for your abilities in a specific area, then prove it through your performance, but do not act as though you deserve it just because your first moments of life were in a Western hospital. As you learn, as time goes on, you’ll figure it out. Keep the great aspects of your home country and culture, leave the rest: Remember, you just became an unofficial ambassador!

Hurry up and wait: Life in the United States and other Western nations is often a little more: go! go! go! than it is elsewhere in the world. Whether you call it the “rat race” or “climbing the corporate ladder” or what have you, many parts of the world don’t do this. Time is more fluid here, and as an example, work starts at 8 for me which, means I arrive between 7:30 and 8:30. For the first year, I was vigilant about being on time. Now I make sure I’m within reason, which is what my co-workers do. This is what makes me part of the group, rather than an outsider. Learn to interpret signals, take things as they come, and just relax. You might find that you really enjoy the more relaxed pace.

Watch what you say, watch what you write: You should be culturally sensitive anyway, but sometimes it takes a little bit to figure out what’s culture and what’s not. I actively wrote a blog the first 18 months I was here; I really enjoy going back and reading it now, as I can see my development and change over the months and year. There’s nothing wrong with doing this, and I actually encourage it. The reason I gave it up was the time commitments of work and school, not fear of Saudi government intervention. That said, it is always a good idea to be aware of what you say. Not every country in the world, including some western ones, recognizes your “right” to say whatever happens to pop into your head today. Insulting a nation’s government or royal family may be illegal, insulting the culture is poorly regarded, and insulting the state religion and/or proselytizing is treated as blasphemy and can be punished severely. If you make it public, anyone can read it.

These are some tips to get you started in your planning process, In my next post, I’ll talk a little bit about the steps to cultural adjustment that you’ll be taking, as well as give some real life examples of people who’ve been both successful and failed miserably in their transitions.


Geoffrey Horning is an Emergency Medical Services (EMS) Training Consultant at the Al-Ghad International Colleges for Applied Health Sciences in Riyadh, Kingdom of Saudi Arabia. His expertise is in EMS/Fire and EMS/Fire Training with specialization in HazMat and Disasters. Geoff’s objective within the Department of Academic and Educational Affairs is to improve and assure the quality of the educational processes and thereby provide the best possible learning environment for students and faculty alike. A veteran of the United States Marine Corps, Geoff is simultaneously working on his MPH at the George Washington University which he will be complete in August 2015.  

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