A Return to Programming in a Pandemic/Post-Pandemic World

by Bill Frederick

The salutations that accompanied 2021’s tentative initial baby steps seemed to be more about wishing for a better new year than for a happy new year. A pandemic year of continuous planning and disruption has made us more cautious. For most study abroad practitioners there was comfort in the quiet New Year’s Eve, that perhaps the election and the emergence of vaccines will allow politics and SARS CoV 2 to recede from their preeminence in our lives.

However, the first weeks of the new year have already seen the U.S. Capital building under siege, a second Trump impeachment and growing concern that the SARS CoV 2 virus mutations may outrun the effectiveness of the newly available vaccines. We should also recall that COVID-19 was not the only cause of program suspensions and cancelations in 2019 - 2020. Tropical cyclones, wildfires, political unrest and disease outbreaks continue to occur more frequently and/or at greater magnitudes than we’ve experienced before. If 2021 does eventually see a significant return to travel for international education, what will the world look like?

January has become the time when travel assistance providers, security agencies and think tanks produce outlooks for the upcoming year. One thing they are making clear this year is that we are not going to be “returning to normal” per se in a post pandemic world. In international education we will be obliged to continue to develop the kinds of technologies, skills and perspectives similar and different to those the pandemic inspired. 

The Hazard Landscape

The most obvious sources of disruption will be political and climate related, but some of the underlying dynamics have evolved such that it will not simply be a resumption of pre COVID-19 trends. 

The Risk Advisory Group, a risk management consultancy, forecasts that nationalism, authoritarianism and populism’s resurgence will intensify in the coming year. Accompanied by the pandemic depletion of their economies, most governments will be focused on competition (internally and externally) as self-interest and unilateralism become the preferred modes of action. The world will be less equal and less liberal. The erosion of the rules based multilateral order is not promising for environmental, economic, social and political problem solving. Pent-up grievances, divisions and disputes will surge and many governments will respond with more aggressive efforts to control their citizens. For education abroad, the most immediate impact may include more political upheaval, protests, an increase in regional conflicts, terrorism and crime. 

You don’t need to be a committed activist with Extinction Rebellion to be alarmed by the climate facts of 2020:

• 2020 is tied with 2016 as the warmest year on record.

• Jan-Feb | Australia – Australia recorded its largest and most destructive bushfire season on record in 2019-20. 

• March-May | East Africa - The region experienced disastrous flooding between March and May. A changing climate is also likely to have contributed to one of the region’s  worst locust invasions in decades.

• June | Russia – Temperatures on 20 June rose to 38 degrees Celsius in the Russian town of Verkhoyansk, the highest recorded north of the Arctic Circle.

• August | US – The Western United States experienced an unprecedented wildfire season with major fires in Oregon, Washington and Colorado. In August, California recorded its first “giga-fire”.

• Oct-Nov | Southeast Asia – severe flooding occurred across Asia, particularly in Southeast Asia where eight cyclones and depressions made landfall between October and November.

• November | North Atlantic (North America/Caribbean) – The North Atlantic Hurricane Season saw 30 tropical storms from July to November, breaking the previous record of 28 (2005) and well above the average of 12. It ended with back-to-back category 4 hurricanes in Central America.

Steven Pinker in Enlightenment Now (2018), used social science data to make the case that the Enlightenment values of reason, science and humanism have brought progress in terms of health, safety, security, prosperity and happiness, making the time of his writing in 2016, the safest and most prosperous time in human history. The pandemic has interrupted that trajectory. Among calamities, the UN projects that 32 million people will be pulled back into extreme poverty this year. Famine, a rarity of late, will become less rare. Political, economic and climate refugees will continue to increase. Pinker’s point is that people with values and intention were able to bring about the most peaceful and prosperous time in history. It could be argued that people with different values and intentions brought us to where we find ourselves today. From this moral perspective, education should have its shoulder to the wheel pushing us towards peace and prosperity. And international education is the vehicle for fostering cross cultural global perspectives as well as a means for developing the social, political, economic and technical expertise that is needed to make the world a better place.  

Lessons Learned

By early summer 2020 schools, camps, the military, professional sports, etc. had experienced COVID outbreaks. Patterns of failure were emerging characterized by COVID-19 risk management plans similar to the risk management plans designed for other hazards. Programs sought out some authoritative guidance, implemented some risk reduction measures and then had outbreaks.  

The “authorities” that provided guidelines for various kinds of operation were ineffective at communicating the limitations of their pronouncements. The CDC was saying that if you choose to do x, y or z, here are some recommended practices for risk reduction. This is very different than saying that if you follow these practices, then it is safe to do x, y and z. Most state and local risk reduction protocols, both domestically and abroad, were designed not to keep individuals safe from infection per se, but to prevent medical facilities from becoming overwhelmed. Allowing indoor dining or nail salon operation is not the same as declaring they are safe.

In the midst of conflicting information regarding disease spread and risk reduction, (3 feet or 6 feet for social distancing? Do masks only protect other people?) recommended measures ranged from easy to awkward and from inexpensive to costly. Cleaning was easy and inexpensive which led to what Derek Thompson called “hygiene theatre” (The Atlantic, July 27, 2020). Programs marketed pages of copy delineating the cleaning products they were using and the frequency of cleaning. It wasn’t until late summer than experts said that fomite transmission was only a theory but that we should continue to wash our hands frequently. For overnight programs, single rooms were not easy or inexpensive. A Marines quarantine program and a number of summer camps failed when they distanced and masked outside during the day and then slept unmasked in close proximity at night. College programs and professional sports teams failed owing to poor protocol compliance management. The White House demonstrated that a rigorous testing regimen was by itself an inadequate strategy. Testing, even in conjunction with other practices, still failed when the timing didn’t follow the science and the research. COVID-19 has proven to be less forgiving than other hazards. Increasing the likelihood of success has required employing all the significant risk reduction measures in layers (the Swiss Cheese Model) and looking at each aspect of program as a link in a chain. Your strategy is only as strong as its weakest link. It has also meant managing compliance as a community responsibility. And it has meant accessing broader authoritative sources of information. 

Study Abroad Adapts

The duty of care for international education organizations has expanded in parallel over the past 25 years with the evolution of digital information and communication technology. Along with the increasing complexity of the hazard landscape, the field has been obliged to develop its risk management capabilities to include the continual application of new technology, the creation of specialized health, safety and security positions within study abroad programs as well as the profusion of security, medical and travel assistance service organizations.

The pandemic has caused a steepening of this developmental curve in a number of ways. 

Many study abroad programs that were using the CDC and the U.S. State Department (USDOS) as decision making handrails prior to the pandemic, had students become infected with COVID-19 and in some cases stranded overseas by the time USDOS level 4 travel advisory was issued. As programs plan for a return to operation, the CDC and USDOS remain important data points, but it has become more common for programs to ensure that they understand the research on a practical level, create their own decision-making algorithms, “aggregate the aggregators” in data collection and to be prepared to make consequential decisions based on a broader network of expertise. 

Sending schools, program providers, vendors, program leaders, students, insurers, etc. have in many instances found themselves renegotiating their relationships. Students are being asked to agree to being more flexible, to share some of the risk, and to accept some limitations on their freedoms. Students, schools, providers and vendors are adding a greater degree of specificity to their agreements such that if programs are disrupted on any given day for a range of reasons, there will be shared expectations about potential refunds or distribution of unspent funds. Programs are examining their agreements with insurers and travel assistance providers and in some cases negotiating details based on a better understanding of the fine print.

We plan our way through successive waves of questions, trying to strategize sensibly in the face of ever-changing known knowns and known unknowns, while wondering what unknown unknowns await us. It is apparent that resilience and responsiveness will be required to successfully operate in the pandemic and post pandemic world. Domestic versions of international programs, online programming and hybrid programs will continue in their own right and serve as backup contingencies for disrupted programming. Providers will diversify their portfolios and their student recruitment pools. Schools will increasingly utilize providers for their expertise and access to existing program infrastructure to facilitate unexpected short notice disruptions. The value of travel assistance services will increasingly be about destination data and analysis. 

And even as we start to look beyond COVID-19, the pandemic threatens to prolong its position in our lives and programming with emerging variants and poorly planned and executed vaccine roll outs. As Amanda Gorman (who studied abroad in Spain) said in her inaugural poem: Where can we find light in this never ending shade? We’ll continue to adapt to an insecure and rapidly changing world and foster the development of poets and problem solvers.

Notes:

https://www.riskadvisory.com/publications/strategic-outlook-2021/home?gated=314479

https://www.riskadvisory.com/events/strategic-outlook-2021-a-preview-briefing/

https://www.internationalsos.com/risk-outlook

https://crisis24.garda.com/global-risk-forecast-2021

https://www.globenewswire.com/news-release/2020/12/02/2138315/0/en/Healix-International-HX-Global-launches-2021-Risk-Forecasts-New-Risk-Oracle-Report-Released-to-the-Public.html

https://news.un.org/en/story/2020/12/1079162

https://www.theatlantic.com/health/archive/2020/09/pandemic-intuition-nightmare-spiral-winter/616204/

https://www.nejm.org/doi/full/10.1056/NEJMoa2029717

https://www.nytimes.com/2020/12/05/health/coronavirus-swiss-cheese-infection-mackay.html

International Programs in the Time of COVID-19

by Bill Frederick

As international education programs strategize for the resumption of operations into this new world there are a couple of paradigm shifts occurring for health, safety and security. First, how we regard safety may be different than prior to COVID-19. Secondly, since the suspension and cancellation of international education programs in March 2020, we need to re-examine the assumptions underlying the role that the CDC and U.S. State Department have played in determining travel policies and operations.

In recent phone conversations, zoom calls and webinars with program managers from a range of educational fields including international education, adventure education, sail training, summer camps, etc., the conversations are similar. There is a surveying of the new COVID-19 landscape, a review of what is known and not known, and the identification of operating protocols from various authorities. Then what follows is a discussion of how to implement these practices and how compliance may be very challenging. At some point the realization sinks in that even with robust compliance with the current best practice protocols, a program cannot objectively quantify or even subjectively qualify that a participant is relatively safe from COVID-19.

However, there are people who want to participate in programs and there are programs that want to run. If everyone understands the risks, is it ok to run? We’ll find out. While many programs have cancelled their schedules variably into the future, there will be programs operating. In the program conversations, many of the educators reported that in the majority of calls they’ve received, the callers expressed hope that operations would resume very soon. Most inquiries did not raise concerns for safety.

International education programs generally manage significant risks first by working to understand them and then by fielding strategies to reduce the likelihood of occurrence and to mitigate potential consequences. If understanding the hazard and risk requires specialized professional knowledge, we access it and follow professional guidelines. If we cannot confidently reduce the risk of a particular aspect of a program to an acceptable level, then we eliminate that aspect from the program. Under current conditions, meaning with no readily available testing to screen for who is currently contagious, and no vaccine, there is no current body of practical protocols that reliably reduces the significant risk of an asymptomatic-person transmitting virus to another program participant. Every program that operates in the current environment is conducting an experiment in a manner that is fundamentally different than any program before COVID-19. It is not “safe”. It is however, usual under our current circumstances.

Different countries, states, towns and individuals are experimenting with a range of strategies or lack thereof, in an effort to return to an optimal level of function in a COVID-19 pandemic world. “We’re in the middle of a global trial-and-error period to try to find the best solution in a very difficult situation,” according to Tom Inglesbury, who directs the Center for Health Security at Johns Hopkins University.

It has become a common experience to wait in lines at grocery stores six feet apart, wearing masks and gloves. How risky is that? We don’t know for sure but for most of us the risk vs. benefit adds up to going to the grocery store. We need food. Most shoppers are likely aware that frontline grocery store workers have contracted COVID-19 despite following best practices. Some have died. Most of us are aware that frontline professional medical workers with training and N95 masks have become sick in the presence of the virus and died.

Now, despite new cases in the U.S. projected by FEMA to be 200,000/day with 3000 deaths/day by June 1st, some states, including many with rising rates of infection, are opening restaurants, barber shops, nail salons, gyms, etc. The risk remains unclear, but there is an increasing willingness to accept a significant but not fully understood risk for things that are definitely not a necessity but which impact our quality of life. Why should educational programs be different? Consenting adults (can make decisions for themselves and for their kids), i.e., programs and participants, can make their own decisions. It becomes an ethical or philosophical (and probably political) issue. And…perhaps a liability issue.

So, who is responsible for safety? There has been a trend of relinquishing responsibility and pushing it downwards. The president has said the federal government is not responsible and that the states need to make their own choices. Some states have implemented strategies to reduce COVID-19 morbidity and mortality based on medical expertise and data. And, they are feeling pressure from increasing quarters to lift any restrictions. When states have lifted restrictions, they have not said it is safe now. They have said that businesses and individuals need to make responsible choices. Businesses may have touted the protocols they are implementing when they open, but they are not saying that they are safe. Most protocols such as the CDC guidelines are presented as suggestions with no binding authority. So, unlike with most health, safety and security best practices international education practitioners cannot point to their compliance with an authoritative standard as evidence of their due diligence. This is different than before COVID-19.

Additionally, most international education programs have historically based their go/no go decisions for travel on the U.S. State Department Travel Advisories and the CDC Travel Notices. On March 1st, 2020 the CDC issued a notice to international education stating: “IHEs (Institutions of Higher Education) should consider asking students participating in international education programs to return to the United States.” They did not change the risk assessments for any country. Nor did the U.S. State Department, except for those countries have the initial significant outbreaks, Italy, Iran and South Korea. Both NAFSA and the Forum on Education Abroad questioned the unprecedented communication from the CDC. Rachel B. Eidex, the Acting Chief, Travelers’ Health Branch, Division of Global Migration and Quarantine, CDC responded in a letter addressed to NAFSA. She clarified that the travel health notices represent the destination assessment at a particular point in time and were not intended to be predictive. She explained the initial communication was not a mandate but intended “to provide institutions with flexibility in their decision making.” The CDC is certainly not assuming any responsibility for decisions made by international education based on CDC assessments. It is clear that the CDC and the U.S. State Department have many stakeholders, some of whom have very different priorities than international education. For many of those stakeholders with business or political concerns riding on the numbers assigned to destinations for which they have an interest, the risk/benefit equation is perhaps different than for most international education programs. By the time both agencies issued worldwide advice against non-essential travel, a significant number of students had already contracted COVID-19 and many were stranded overseas (some students who claimed they had been stranded had ignored their university’s initial suggestion or directive to return home). In future the travel advisories and travel notices will likely remain important data points, but international education can no longer rely on them as handrails for decision making.

International education has been successfully adapting to a changing world since its beginning. The evolution of information and communication technologies has allowed us to do things that were once unimaginable and to adapt to the increasing pace of change in the hazard landscape over the past 25 years.

While COVID-19 was by far the most disruptive, it was not the only event that resulted in program suspensions and cancellations in 2019 - 2020. Emerging diseases, tropical cyclones, wildfires and protests are not unfamiliar hazards. However, the magnitude of the events we saw in 2019 was new. And COVID-19 is likely to be with us for some time.

To fulfill our missions, we’ll need the flexibility, acceleration and resilience to stand up programs rapidly and to stand them down in a timely manner. We’ll need faster and better information acquisition and analysis strategies. We’ll need to upgrade our systems and protocols. We’ll need to renegotiate relationships between students and their programs, universities and their providers, and between programs and vendors, insurers, travel assistance providers, etc.

Navigating international education into this new world will require a recalibration of our compasses. We’ll need to revisit our values, purpose and risk tolerance. It will require new thinking on risk management decision-making, and the standards, authorities and other stars by which we steer.

The Pedagogical Value of Risk in Study Abroad - Part 1 Students Are Not Trained to Manage Risk

by Bill Frederick

The majority of university-sponsored study abroad programs offer, provide and in many cases require some formal pre-departure orientation that is in part concerned with conveying concerns about health, safety and security. Additionally, many of them, as well as most program providers, require some additional in-country risk management orientation. Additional safety briefings often precede specific program activities. However, most health, safety and security education for students is relatively brief. At a recent Forum on Education Abroad Standards Institute: Beyond the Basics of Health, Safety and Security, an informal poll was taken regarding student orientations. This event was largely attended by staff from those institutions with a significant commitment to health, safety and security. Many of them have at least one full time position dedicated to safety and sent them to this conference. So it is likely the case that their institutions do better than most along most risk management indicators. It turns out that for this group two hours or less is typical for a student study abroad orientation. The format for most was information transmission. The Forum on Education Abroad’s Critical Incident Database (2010, 2014) has consistently indicated that poor judgment (presumably on the part of students) is the number one contributing factor for health, safety and security incidents. And yet higher education study abroad programs do not typically make significant efforts to train their students. There are a number of complex assumptions underlying this, many of which may simply not be true.

Currently, most study abroad programs have some staff at least partially dedicated to risk management. In some cases, more than one staff person is fully dedicated to health, safety and security. Programs spend enormous sums on external expertise for evacuation and repatriation, medical and mental health oversight, security intelligence, student tracking services, communications, vetting, etc. Why do we spend so little time and expense on developing student risk management skills?

The Questions

There is research that supports the belief that college students are not cognitively capable of managing their risk taking behavior. There is additional research that supports the idea that training students to manage their risks is ineffective. The view that has emerged of the contemporary college cohort is consistent with that of Peter Arnett’s emerging adults, i.e., not really fully adults. What if these prevailing beliefs are wrong? Are we spending millions of dollars every year on risk management but focusing on the wrong things? What if biology is not destiny and that many of the limiting beliefs about the capacities of college students are cultural?

The Research

A Social Neuroscience Perspective on Adolescent Risk Taking (Steinberg 2008) surveys much of the research that underpins the proposition that the management of risk taking behavior that characterizes the transition from adolescence to adulthood is mediated by the maturation of structures in the pre-frontal cortex which is not complete until close to the age of 25. Brain scanning has allowed researchers to monitor changes in the brain and to track arousal of specific areas of the brain when the individual is engaged with specific tasks. There are three major changes to the brain that occur during adolescence, all having to do with improving neural networks (Paus 2005). In the prefrontal cortex there is pruning of unused pathways, increasing the myelin sheathing of other pathways, and increasing connectivity with other areas of the brain. However, these observable developments are all complete by the age of 20. Assumptions regarding additional maturation of some structures are based on performance on psychological tests intended to measure executive function and the observed increasing recruitment of certain parts of the pre-frontal cortex when engaged in planning, deferred gratification, etc. While the implications of this research are very interesting from a risk management perspective, it does appear to assume that the data generated by students taking written psychological tests is directly applicable to real world risk management. Additionally, the research does not imply that everyone under the age of 25 is incompetent at managing risk or that anyone over the age of 25 is necessarily competent. It is essentially saying that while the process may be significantly complete by the age of 20, the process continues for some additional years.

Earlier research looked at questions of whether or not adolescents processed or perceived information about risk differently or if adolescents were simply less risk averse. But that research showed no essential differences between adolescents and adults in terms of their perception of risk or their perception of their relative vulnerability (Millstein & Halpern-Felsher, 2002; Reyna and Farley, 2006; Steinberg and Cauffman, 1996).

Studies cited as evidence in a 2006 CDC study that education based approaches are ineffective at reducing adolescent risk taking come primarily from high school health education programs designed to reduce behavior specific to smoking, drinking, drug use, safe sex and driving. Such programs are informational in nature. They provide explanations of the consequences of risky behavior. A survey of the literature does demonstrate that such programs are successful at increasing participant knowledge but not at changing behavior (Steinberg, 2004, 2007). The apparent underlying assumption was that providing information would change behavior.

So, brain maturation in regards to the pre-frontal cortex is mostly complete by the time that most students go abroad. And, most study abroad practitioners would likely agree that most of their students do in fact successfully manage their risks quite well while abroad. Program risk managers spend most of their time responding to incidents that involve a very small percentage of their students. And simply providing information is ineffective at improving risk management behavior.

What is effective at improving risk management behavior?

Skill Building Versus Providing Information: A Story from Study Abroad

On the last night of a semester program, a female student was sexually assaulted by a local man. The perpetrator was part of a group of local men who were regarded by the program as predatory in the sense that they were adept at identifying particularly vulnerable students and manipulating them into having sex after which many expressed strong regret, anger, shame, etc.

Part of the student orientation always included a briefing about these men and the local bar scene. Conveying this information to students appeared to have little to no effect on how individual students or the student group in general behaved at the bars or how they interacted with these men. After the assault, the program contacted all of the incoming students prior to the beginning of the subsequent semester to inform them of this event. A lot of the next semester’s in-country orientation focused on the sexual assault and how to stay safe. There was no apparent change in student behavior. In subsequent semester orientations a number of approaches were tried. At one point the local police were invited to participate and they conducted a slide show of local predators and their related criminal backgrounds. No amount of information appeared to have any impact. While there were no additional known sexual assaults, there apparently were some students who did feel preyed upon. It should be mentioned that not all local men were predatory nor was all sex between students and local men regretted.

A year after the sexual assault, a Peace Corps rape crisis counselor informed the program of a book by Gavin de Becker entitled The Gift of Fear. In part it describes seven common manipulative ploys used by predators to turn people into prey. The program created a curriculum based on it. The curriculum consisted of presenting information regarding patterns of manipulative behavior and then having students practice recognizing those patterns. They’d then role-play responses while engaged in interaction where the role players tried to utilize very specific ploys to manipulate them. It appeared to prove very effective. When students recognized any of these strategies being used on them, the game was over. They’d also practiced how to extricate themselves from an interaction without conflict or escalation.

Training for Risk Management

Exercising good judgment in an international setting is a skill. It requires information transmission, but additionally it requires opportunities to apply knowledge and to get performance feedback when you fail or succeed to varying degrees. To simply provide information to students regarding navigating health, safety and security abroad and then expect them to exercise good judgment is akin to presenting a PowerPoint about gymnastics to students an expecting them to be able to execute complicated gymnastic routine.

Skill building takes time. This training took about 2 hours and only addressed one particular aspect of risk management, i.e., how to avoid being mugged, sexually assaulted or hustled. And the students didn’t master these skills, but they did develop a working capability and a foundation for further development. Putting together a travel health strategy and maintaining it is a skill. Being able to maintain situational awareness without being paranoid is a skill. Observation (understanding what you see) is a skill. Cross-cultural competence is a range of skills. How to develop personal insight is a skill. First aid is a range of skills (generally, people who have learned real first aid skills become much better at avoiding getting injured). These are the skills that might really impact our students’ safety overseas. And any skills-based training intended to train students to navigate health, safety and security abroad would at least 2 days, not 2 hours. Study abroad practitioners to greater and lesser degrees have developed these skills experientially during their travels over a protracted period of time. They are also educators. Health, safety and security informational content is readily available. Putting together exercises and experiences designed to foster skill development requires some work but isn’t outside the skill sets of most study abroad departments. The key is understanding that skills-based training is effective. Perhaps the most challenging aspect of implementing an effective skills based training scheme is carving out time and budget and requiring students to attend. On the other hand, not effectively addressing the primary contributing factor to health, safety and security incidents has its own time and budgetary implications.

Recreational Water Activities Abroad

by Bill Frederick and Captain Rick Miller

Some of the more frequent recreational activities in which students engage while abroad involve water and swimming. These can be as organized program activities or on student free time. Understanding the variables regarding swim environments, supervision, ability level, lifeguarding and policies, can help a program manage risk and reduce the likelihood of a drowning or near drowning while abroad.

Google searches usually turn up tragic events only if the story found its way into a newspaper. A Google search for drowning events in international education programs doesn’t tell us definitively how many students drowned during any given time period. A recent search does show that in 2016 – 2017, teenagers on international education programs drowned in swimming pools, in the ocean, in shallow rivers and hotel lagoons in Europe, Africa, Latin America and the Caribbean.

Supervision

In some of the instances there was no supervision, but in some cases there was a high ratio of staff to students (better than 4 – 1). Having untrained adults in close proximity is not an effective water safety strategy as illustrated by easily found YouTube videos of unconscious drowning youngsters bumping right up against adults at water parks who do not recognize that there is a problem.

An ongoing informal survey of secondary school global programs that do allow swimming on international programs shows that very few programs have formal policies. It is left up to chaperones to decide if swimming may occur in any particular venue or circumstance. There are no requirements for the chaperones themselves to have any expertise in recreational water safety. They are not usually required to indicate whether or not they can themselves swim.

Lifeguarding

Lifeguarding courses available in the United States are intended to train lifeguards for swimming pools or waterparks. Most “certified life guards” don’t know anything about rip currents, surf beachfronts or river hydrology. Most lifeguards who work on beaches with any kind of current or surf, showed up with their YMCA/American Red Cross/American Lifeguard Association certification and then, after passing a much more rigorous swimming assessment, were taught the skills they might actually have to use. The United States Lifesaving Association (USLA), which sets the standard for open water supervision and surf rescue, does not offer training or certification to individuals. They certify “agencies” which usually means a township that has surf beaches and a professional lifeguarding staff, which needs to conduct trainings and maintain lifeguarding operations that comply with the USLA standards. The USLA certification does not apply to individuals so even if you had staff who’d been open water/surf beach life guards, they do not carry any current certification for that activity.

Assessing Swimming Environments

There are many, many possible swimming environments: ocean beaches with varying degrees of surf (waves), rivers whose hazards change depending upon the level of water, waterfalls, quarries, kettle ponds, volcanic lakes, hotel pools, waterparks, etc.  Rip currents, keeper holes, foot entrapments, strainers, air temperature, water temperature, visibility, potentially dangerous marine life, pollutants, etc. are a few of the many potential hazards that need to be competently assessed by people with skills and experience. It is more than just common sense.

Swimming Assessment

When gauging swimming ability, it’s important to ask who is doing the assessment and the criteria for determining the assessment.

I’ve twice been obliged to rescue university faculty who had clearly indicated that they were competent swimmers prior to an in water swimming assessment. Without any hesitation they had jumped into the water and proceeded to drown.

In one post rescue conversation, the professor logically pointed out that he had never been swimming before, so he didn’t know that he couldn’t swim. In a semester long collegiate program, one of the staff (a former Olympic trials contender) liked to swim from shore out to a number of shallow shipwrecks. Two students convinced him that, despite his warnings of strong currents, they were very strong swimmers. One claimed a history of being a lifeguard. One claimed to have passed “the Navy Seal swim test”. The staff person had to rescue both of them swimming one at a time onto a buoy and then swimming back in to get a motorboat to pick them up. Swimming self-assessments are wholly unreliable.

In one of the teenager drowning stories, the program pointed to the fact that they had a waiver signed by the victim’s parents stating that he knew how “to swim”. The language around swimming in that document was general and very much open to interpretation. Some families who have spent extensive time in shallow water lakes, pools or beaches are doing what they called “swimming”. When asked if their child can swim they rightly believe that their child frequently goes swimming and therefore they know how to swim. This is qualitatively different from someone who can get from point A to point B in water over their heads using intuitive movements (“doggy paddle”) while keeping their face as far from the water as possible. This is also qualitatively different from someone who puts their face in the water and can demonstrate proficiency in a number of recognized competitive strokes (freestyle or crawl, breaststroke, backstroke or butterfly).

It is recommended that programs that allow swimming should assess swimming ability prior to departure. Students should be asked about their ability individually out of earshot of the group so as to avoid possible embarrassment.  This allows the assessors to gauge the self-assessment skill of the student and also allows the assessors to have the student wear a personal flotation device (PFD) if appropriate. The assessment should be conducted in an environment where it is easy to visualize the student being assessed and where the assessors can get to the student very quickly if need be. The assessment is not intended to gauge endurance. A typical exercise would be to have the student swim 25 yards using freestyle and 25 yards using the stroke of their choice and then tread water for 60 seconds. What is being assessed is skill level, confidence and comfort in the water.

A commonly reported pitfall is simply making a distinction between swimmer and non-swimmer and feeling pressure to assess anyone who can traverse the 50 yards as a swimmer.

There should be at least 4 distinctions:

Level 1 – non-swimmer – cannot travel 50 yards

Level 2 – adequate swimmer - can travel 50 yards and stay afloat for 60 seconds, but does not put face in the water between each stroke or is unable to demonstrate proficiency in any competitive strokes.

Level 3 – proficient swimmer – can demonstrate proficiency in freestyle, i.e., put their face in the water and coordinate breathing between strokes.

Level 4 – competitive swimmer – demonstrates proficiency in freestyle and other competitive strokes and has been training with a swim team at some point during previous year.

As a result of the assessment, there should be difference limitations imposed on students depending upon their swimming ability. In a hotel pool, a level 1 swimmer can only swim in a pool with 100% supervision with a PFD on. Adequate swimmers may only swim with 100% supervision.

In a more challenging environment the school may require both non-swimmers and adequate swimmers to wear PFDs at all times with a specified level of trained supervision.

PFDs

Personal flotation devices come in 5 types. (From Wikipedia)

Type I PFD’s – Off-shore life jackets: These are the best devices for all waters, open ocean, rough seas or remote water where rescue may be slow in coming. This type of device is also used as abandon-ship life jackets for commercial vessels and all vessels carrying passengers for hire.

Type II PFD’s – Near-shore buoyant vests: For general boating activities, calm inland waters or where there is a good chance for fast rescue.

Type III PFD’s – Flotation aids: For general boating or specialized activity that is marked on the device (such as water skiing, canoeing, kayaking, hunting etc.). These devices are best for calm inland waters or where there is a good chance for fast rescue.

Type IV PFD’s – Throwable devices: these devices are designed to be thrown to persons in distress. Often this type of device includes boat seat cushions, ring buoys and horseshoe buoys. These are not designed to be worn and should be supplemented by a wearable PFD. Both the throwable and wearable devices should be readily available for emergency situations.

Type V PFD’s – Special use devices: Used only for special uses and conditions. Typically these are labeled with their limits of use. Commonly these flotation devices are used for canoeing/kayaking, boardsailing, deck suits, work vests for commercial vessels and man over-board situations and law enforcement.

An important part of having and using a PFD is the fit. PFDs should fit comfortably and snug. It is important to try the PFD on before use. It should not ride up your body. To test whether the PFD has the correct buoyancy for your weight, when lying on your back in water and relaxing, the PFD should keep your chin well above water. If it does not, a device with higher buoyancy is needed.

The fit of the PFD is as critical as having the right type device for the right circumstance. We were recently asked by a client to look into a cave tubing activity they had scheduled for a program in Belize. We spoke to participants from previous trips who’d felt that it was actually less exciting than they’d hoped. The cave was simple (no alternative passages) and the water was slow moving without any whitewater. However, a quick search turned up that a 52 year-old nurse drowned during the activity in 2008 when her tube overturned after brushing up against the wall. The cause of death was drowning. The program was using (and still is using) type II life vests that are best used when a quick rescue is anticipated.

In low and middle-income countries in particular, most adventure activities, including those that involve water (rafting, sea kayaking, surfing, etc.) will not be conducted at a similar standard as they likely would in the U. S. In part regulation, regulation enforcement and torte law are all under-developed. Providers are not concerned about being sued and expensive safety equipment and training detracts from the bottom line.

Conducting recreational water based activities overseas is a common and usual activity. However, while rare, drowning events make up a significant proportion of international education program fatalities. The risks are not always immediately apparent. A competent recreational water safety strategy involves ensuring that all the pieces are in place.

Managing the Threat of Terrorism and the Wisdom of Insecurity in Education Abroad

Photo courtesy of Google Images

by Bill Frederick

While the risk of random terrorist violence victimizing education abroad students is low, concern for it looms large in the minds of students, their families and education abroad practitioners. It is in part because the idea of it is so much more disturbing than the more mundane hazards we routinely encounter. As David Ropeik might suggest, people who swim a little but drive a lot, are more likely to fret about shark attacks than motor vehicle accidents.

But as attacks have increased across Europe, where most American students go to education abroad, we’ve begun to look for opportunities to manage the risk. The various measures being employed or considered can be categorized as prevention (before you go), avoidance (what to do while there) and response (what to do if an event occurs).

Prevention has largely been a matter of getting security intelligence and making decisions about what destinations to avoid. At the most rudimentary end of the due diligence continuum, many programs simply rely on the U.S. State Department travel warnings and alerts. At the high end, more and more programs are getting their intelligence from professional security outfits (iJET, Control Risks, Drum Cussac) sometimes directly and sometimes through their travel assistance providers.

Additionally, programs are scrutinizing the kinds of venues where terrorist attacks have been most frequent, i.e., low security situations where there are a lot of people - outside concerts, sporting events, walking malls, public celebrations, etc. When putting together itineraries, program leaders make determinations about avoiding exposure, minimizing exposure or accepting some exposure.

At airports the most frequent target zone has become the area between where travelers arrive at the airport and where they bottleneck at check in lines and in pre-security lines. By doing check in and ticketing before arriving at the airport and ensuring that all bags are within weight regulations, travelers can reduce the time spent in the target zone.

When considering whether or not to have a group join a public event, it would be good to know what sort of security is in place. Is there a significant police presence? Are there security cameras? Do the police periodically sweep the area looking for unattended backpacks? Have garbage cans been removed from the area? Are manhole covers welded shut? Have bollards or other obstacles been installed to reduce the likelihood of someone using a vehicle as a weapon as in Nice, Barcelona or Charlottesville?

By way of response, many groups are now routinely designating meeting points in the event of the group being separated because of a terrorist event, a hotel fire, an earthquake or a stampede such as the one that took place in Turin after a crowd outside a soccer match mistook firecrackers for gun shots.

Technology and new security service organizations are increasingly part of the everyday security equation. Devices that were initially developed for wilderness travel that allow a smartphone to become a satellite texting device are turning up more and more frequently on the streets of European capitals to be used in the event that cellphone circuits become overloaded, as happens in most high profile events, or are destroyed, as happens with many natural disasters. There are apps that allow group members to contact all other group members very quickly, or that allow an SOS message to be sent to designated recipients quickly. There are apps that receive security alerts from professional security organizations and apps that allow all phones to be located at any given moment.

Training may become more important. Currently, most training for program leaders or participants is limited to a promotion of situational awareness. For example, using “Cooper Color Code” (US Marine Corps) - get out of the white zone of being unprepared and unready to take action. Practice being in the yellow zone where you are prepared, alert and relaxed. It is critical to not lose the relaxed part of the yellow zone. You can’t and don’t want to sustain a more hyper aroused or stressed state as it is unsustainable and you’ll reduce the potential quality of your education abroad experience. Removing ear buds and reducing the time spent on portable screens is a good start. Attend to what is going on around you.

A secondary school group was at their departure airport preparing to go abroad in January 2017 when a shooter in an adjacent terminal began firing. The program leaders reported that they responded more effectively as a result of the scenario based training that they’d participated in one month prior. The training they’d taken was not focused on terrorism. It required that they work through a variety of more likely emergencies, but having worked through multiple scenarios that required their agency, they did not think of themselves as passive bystanders to which the shooting was happening. They responded. They were primed to initiate action.

There are training modalities typically utilized by law enforcement and the military that constitute a highly educated and informed yellow zone. They learn how to attend to body language, physiological tell signs, the way people are interacting and how the surrounding scene appears in relation to how it normally appears. This kind of training essentially make its practitioners explicitly aware of the signs that cause the “gut feelings” of unconsciously perceived intuition. For education abroad practitioners, the time required to develop these sorts of skills is unrealistic.

It is also worth understanding how we typically respond and how we are wired to respond.

Often we do not recognize danger. There is a tendency not to. We protect our emotional equilibrium. We normalize the data coming in. The pop, pop, pop we hear must be firecrackers or a car backfiring (until we see others running). The smoke we smell must be from someone’s fireplace. When we don’t know what to do, we do something that is familiar. A number of survivors reported that after they’d felt the impact of the planes hitting the World Trade Centers, they’d spent a surprising amount of time straightening their offices and in one case even knitting before they headed to the stairwells.

Sometimes we recognize danger in an unconscious manner. Especially if we’ve been exposed to it before, the unconscious part of our brains may recognize it well before the awareness dawns. Having evolved in the savannas of Africa for most of our evolution, we respond to sudden danger in predictable ways. Most of the physiological response and behavior is directed towards surviving an attack by a predator. Prior to awareness, our limbic system goes on alert. Our amygdala starts to fire off. The conscious problem solving part of our brain shuts down. Our minds go into a search mode for the script for how to respond. Glands release hormones that will allow us to run faster and fight harder and feel less pain. Blood is shunted to large motor muscle groups in preparation for action. This response was what we were naturally selected for, but it is largely maladaptive in most of our current circumstances. In by far the majority of instances, we need the problem solving part of our brain to come back online as quickly as possible. Being aware of how this normal response works, may help us pass through it more quickly.

For most of us, all of this concern for security may seem way out of balance and very far removed from why we chose to work in international education. But perhaps there is an unintended benefit for education abroad from these kinds of threats.

In Tribe, Sebastian Junger writes about how much healthier we are when faced with calamity. After the World Trade attacks, the suicide rate in NYC declined for the following two years, the rate of new prescriptions for psychotropic medications dropped, etc. He writes about groups in war being tribal. Everyone in a group (a patrol, a firebase team, etc.) has meaning and purpose, which is developed in the context of the group. Individual differences are trivial. Preoccupation with personal wants and needs drops off in favor of the needs of the larger group. The only real sin is selfishness.

Rebecca Solnit, in A Paradise Built in Hell, writes that people have a tendency to respond very well during disasters. While normal people are often portrayed in the media as behaving horrifically (think Katrina) during natural and man made disasters, research actually shows that the opposite is usually the case. People evacuating from crashed airplanes, burning buildings, etc. tend to be orderly and not to panic. Most survivors, pulled from the rubble after an earthquake, are rescued by normal people. However, what is most often seen in the news is professional rescuers saving the last few because the media only arrives in time for those stories. The Boston marathon bombing was an exception because the media were already there. Most of the leading stories were of bystanders applying tourniquets and taking care of the injured.  Additionally, people often recall the time following a disaster as a period when they felt closest to other people, when they felt they had the most purpose and meaning in their lives.

Robert Thurman, the foremost American scholar of Tibetan Buddhism (and actor Uma’s dad) once said that in the Tibetan Buddhist cosmology there are multiple different realms. The name of the world that we all inhabit translates to “barely tolerable”. It is considered a desirable place to be reborn because it is harsh enough that you are obliged to learn what is important to learn but not so harsh as to make it impossible to learn.

Many of the stories that education abroad practitioners tell about the current generation of education abroad students are not flattering. They would be consistent with Jeffery Arnett’s “emerging adults” and the recent discovery of their late maturation.5 The growth of mental health problems, binge drinking, discomfort with ambivalence and ambiguity, an all abiding tolerance not based on conviction so much as not wanting to be judged themselves, the need for safe spaces, etc. Solnit points out that many of our ills may be owing to our primary focus on the personal and the private and our preoccupation with entertainment and consumerism. As both Solnit and Junger point out, calamity obliges us to look beyond ourselves and to necessarily regard our relationships with each other differently as the context for discovering unsuspected capacities, meaning and purpose. And while no rational person would wish to create the risk of random terrorist violence, it is here and it may have high pedagogic value even as we strive to manage that risk.

From the New York Times Editorial Board on September 18, 2016 in response to the coordinated bombings in Chelsea, NY and NJ:

“The right response to this constant, unending, low-level threat of sudden violence is to stay vigilant and reasonable, to clean up the damage, care for the injured, look out for one another, and elect leaders who will address the challenge with sanity and good judgment. And avoid the wrong responses: A police-state overreaction would be equally damaging in its own way by adding to the intolerance and suspicion that can foster radicalization, isolation and hatred.”

NOTES

David, R. and Gray, G. (2002) Risk: A Practical Guide for Deciding What’s Really Dangerous in the World Around You. Houghton Mifflin Company, New York.

Junger, S. (2016) Tribe: On Homecoming and Belonging. Twelve, New York.

Solnit, R. (2010) A Paradise Built in Hell: The Extraordinary Communities That Arise In Disaster. Penguin Random House, New York

See Robert Thurman, www.bobthurman.com

Arnett, J. (2014) Emerging Adulthood: The Winding Road from the Late Teens Through the Twenties (2nd Edition). Oxford University Press

The Editorial Board (2016) Reason and Vigilance After the Blast. New York Times. September 18, 2016. https://www.nytimes.com/2016/09/19/opinion/reason-and-vigilance

Legal Ruling Helps Identify Strategies for Managing Discretionary Free Time

Photo by Christopher Burns on Unsplash

by Bill Frederick

When are college students responsible for their own health, safety and security while studying abroad and, under what circumstances is the school or the program responsible? This is not a simple question but a recent court case and its subsequent unsuccessful appeal should be heeded by administrators and used to inform their risk management strategies around student discretionary free time.

In 2009 Morgan Boisson, then an undergraduate student at the University of Arizona, along with 14 of 16 students spending the semester at Nanjing American University (NAU) in China, decided to travel to Everest Base Camp at 18,000 feet where Morgan subsequently died of altitude illness.

Elizabeth Boisson, Morgan’s mother, filed a civil suit against the Arizona Board of Regents, the State of Arizona and the provider, Nanjing American University (an Arizona LLC).

In a civil court case there is an underlying assumption that if you do something that causes someone harm, whether intentional or not, the harmed party is entitled to compensation from you. When educational programs are defending themselves in a civil court against a participant, the most likely charge is negligence. In order to establish negligence it needs to be shown that four conditions exist. 1. There is harm 2. There was a duty, 3. The duty was breached (not fulfilled) and, 4. Causation, i.e., the breach of the duty caused the harm.

The harm was clear in this case and no one would argue that a university or a program doesn’t owe some duty to their students or participants. However, the nature and extent of what that duty might be is very arguable. In this case it was the crux issue as questions of breach of duty and causation rest upon how the duty is defined.

The intricacies of civil law and what constitutes a duty is beyond the scope of this article. The Arizona court said that the trip was not an off campus school activity for which defendants owed Morgan a duty.  And, in that determination the court articulated some questions derived from Arizona case law that might be useful for all higher education study abroad programs to consider. While law varies from state to state, these questions may help to guide some decision making regarding how to structure program time versus discretionary free time:

• What was the purpose of the activity (how related to program goals was it?)?
• Was the activity part of the course curriculum?
• Did the school have supervisory authority and responsibility during the activity?
• Were the risks students were exposed to during the activity independent of school involvement?
• Was the activity voluntary or required by the school?
• Was a school employee present at or did any participate in the activity or was there an expectation that a school employee would do so?
• Did the activity involve a dangerous project initiated at school but built off campus?

These questions suggest a strategic approach for reducing liability exposure.

Presumably, a program activity that is managed by the program will have the benefit of the institution’s health, safety and security strategies. There are other activities that students may engage in between the time they depart for the program and the time that they return from the program that are not managed by the program and for which program safety strategies are not operational. Some of these times are clearly the participants’ discretionary free time. However, should the program staff make recommendations for what to do during such periods, or provide support for those times, or should staff accompany participants during those activities, the status of those periods as being non-program time may become less clear. Programs clearly have responsibility for what happens during program time and they have maximal control over what happens during program time. The worst scenario from a liability perspective is when the program has allowed the boundaries to be so unclear that they have maximal responsibility for an activity, but minimal control over the activity.

In fact, in Boisson v. Arizona Board et al, a number of events were argued as demonstrating that the trip was in fact a school activity. In one instance a school employee had assisted the students in making their flight reservations. In another, some professors had adjusted their class calendars in order to accommodate the students’ travel. Those events were not enough to tilt the ruling in the other direction but it would be easy to see how just a few different factors might have made a difference. What if all the students had chosen to go? What if any staff member no matter how junior had accompanied the trip? What if a professor had provided assistance or advice or had made recommendations for lodging or transportation? It is also not difficult to imagine a student telling their parents that it is a school-sponsored event in order to secure their permission or their financial support for it. None of these by themselves is damning but each makes the status of the trip increasingly gray.

Strategically, it makes sense to reduce the gray area to the degree that is practical.

Most programs cannot entirely eliminate gray areas. A program that has transported its students to a particular locale for program purposes can’t simply declare their evening out to be non-program time and expect to be absolved of all responsibility and reliably free of liability exposure. But programs can find opportunities to build firewalls between program time and discretionary free time.

• Be crystal clear about when and where programs start and end.
• Be clear about when and where mid program breaks begin and end.
• Don’t allow your program to become over-involved in students’ planning their break time or post program time and avoid having your staff participating in break time or post program times with students.

And, while we need to attend to liability issues, safety is the primary concern. It would be a particularly bad idea to withhold advice or information from your students when they are making personal plans owing to concerns about increasing liability, when you know that you might be increasing their risk by doing so. From a liability perspective the best strategy is to reduce the likelihood of harm to your students. No harm means no liability. Secondarily, it makes sense to build firewalls between program time and non-program time.

Legal Ruling Serves to Focus Program Health and Safety Strategy (Munn v. The Hotchkiss School)

by Bill Frederick

In 2007, Cara Munn, a student attending The Hotchkiss School, suffered permanently debilitating tick-borne encephalitis while on a study abroad trip to China. In 2013 a Connecticut court awarded her $41.75 million dollars (Munn v. Hotchkiss School). There is an appeal underway and in August 2017 the Connecticut Supreme Court was asked to answer two questions pertinent to the appeal. The court said that: 1.) The public policy of Connecticut does not preclude imposing a duty on a school to warn about or to protect against the risk of a serious insect-borne disease when organizing a trip abroad and, 2.) The jury award to the plaintiff fell within the necessarily uncertain limits of just damages and did not warrant a remittitur. The case now goes back to the Second Circuit Court of Appeals. In her concurrence on the two questions before the court, Connecticut Supreme Court Justice Carmen E. Espinosa raised significant questions around foreseeability that suggests that it might be reconsidered in the appeal.

Regardless of how the overall appeal plays out, the Connecticut Supreme Court has made a statement. It may be specific to Connecticut and applicable to secondary schools and minors with the corresponding legal notions of custodial care and In Loco Parentis, but it suggests that all secondary schools (and perhaps gap year programs, higher education and all the subsets of international education to varying degrees) need to “warn about” and “protect against the risk of a serious insect-borne disease when organizing a trip abroad.”

There is a spectrum of measures across each category that might be undertaken to warn about and protect against the risk of vector-borne diseases.  Programs make the strategic error of doing the minimum. The logic is that whatever measure taken would demonstrate the performance of due diligence. However, the only sure way to guarantee your school or program’s protection from vector-borne disease related liability is to ensure your students don’t get these diseases. And, no matter what precautions you implement, there is still some chance of disease. Whether a school or program has done a great job of taking care of their students may be determined by a judge or a jury. Arguing that minimal measures should protect your organization from the letter of the law, when they obviously didn’t protect your student from a potentially serious illness, is not the argument that you want to be making. In the face of a potentially tragic event, you will be wishing that you were able to point confidently and competently at a well thought-out and robust strategy. Categories for warning and protection include:

• Understanding the hazard
• Warning
• Preventative measures (before you go)
• Avoidance measures (while you are there)
• Response measures (what to do if someone becomes ill)
• Understanding the hazard

In order to warn or protect from insect-borne diseases, every program and program leader need to know what diseases are endemic at their destination, which diseases pose a threat, and the best measures for prevention, avoidance and response. Different countries have differing recommendations for vaccines and chemoprophylaxis, but for U.S. based institutions and programs, the U.S. Centers for Disease Control (CDC) is the accepted authority. You can go to the CDC website for information or you can subscribe to a medical intelligence service like TravelCare® International, LLC that will organize the information in a very accessible format and which is consistent with the CDC. Additionally, if your school has a relationship with a travel medicine doctor, nurse or clinic, you can ask them to put together information summaries for staff. Some travel assistance companies provide vector-borne disease information to their clients. Finally, there are a number of online courses in travel health available and short courses for lay-persons in travel medicine (Travel Medicine First Aid) are also available.

Warning

There are degrees of warning. At a minimum you could forward a link to the CDC website to participants, and their families in the case of minors. A better approach would be to cut and paste the relevant sections into an email. Even better would be to use TravelCare® to forward a report to your participants. Orientations should include an overview of all the likely risks including insect-borne diseases and the best prevention and avoidance measures. Orientation content and student preparation processes should be well documented.

Preventative Measures (before you go)

The CDC makes recommendations for vaccines and chemoprophylaxis. A couple of vector-borne diseases are preventable with vaccines, i.e., yellow fever and Japanese encephalitis. The best preventative strategy for malaria is chemoprophylaxis (taking medication to prevent getting a disease). The CDC recommends 5 different drugs with varying regimens, effectiveness and side effects.

• Chloroquine – Chloriquine resistant malaria has grown significantly around the world particularly in the most dangerous strain of malaria (P. falciparum) making this a less likely choice.
• Doxycycline – Requires a daily dose. It once was considered to be inexpensive, but as the primary treatment for Lyme disease and having become the primary chemoprophylaxis for the U.S. military, it is no longer inexpensive. It has two particularly notable side effects. It can cause photosensitivity, making users very prone to severe sunburn. It also may cause fungal infections (vaginal and esphogeal). On the plus side it may also protect against some tick borne infections.
• Mefloquine (Lariam) – Requires a weekly dose and is the least expensive chemoprophylaxis. It has a very notable side effect in that it frequently causes very vivid dreams and other neurologic issues. It is not recommended for anyone who has any history of mental health challenges or seizures. Some resistance is reported in Southeast Asia.
• Atovaquone/proguanil (Malarone)  - A daily regimen. Not inexpensive. Anecdotally, there are comparatively fewer side effects reported, mostly gastrointestinal issues.
• Primaquine – This drug should not be taken by anyone with a liver enzyme (glucose – 6 – phosphate dehydrogenase) deficiency and anyone considering should be tested for it. This drug kills the malaria parasites in the liver (as opposed to the bloodstream), which may make it a good choice if you are particularly concerned about P. ovale and P. vivax.

Avoidance Measures (what to do while in country)

When you know what the vector hazards are at your destination, it is then important to understand if the vector is primarily a day biter or a night biter. The mosquito that carries malaria; sand flies that can carry leishmaniasis; and the triatomine bugs that carry American trypanosomiasis (Chagas disease), are all primarily night biters. The Aedes aegypti mosquito, which carries dengue, Zika, chikungunya and yellow fever, is primarily a day biter (and urban dweller). In some regions where malaria is not a threat, it may still make sense to use chemically treated mosquito nets at night. And, whether you are concerned about day biters or night biters, avoid sitting outside at a café unprotected at dawn or dusk when mosquitos are most active.

It is also important to understand that not all insect repellents are created equally. If you went bug repellent shopping at a Walmart or an REI, many of the products you’d find are not very effective. There are there 3 products that research shows are effective: Products with DEET (N,N-Diethyl-meta-toluamide) with a concentration somewhere between a 25% - 35% are optimal foreffectiveness. The other two effective products are picaridin and IR3535. Additionally, there are products that sound like they might be good for your skin. They smell great and sound minimally toxic. Their ingredients may have repellent properties, but the time frame of effectiveness is so brief that by the time you’ve finished applying it, it is time to reapply it. Long sleeves and long pants afford protection. For additional protection, especially against ticks, you could apply permithrin, an insecticide, to your clothes.

Compliance with avoidance measures is another issue. Last month I was teaching a travel medicine course in Chiang Mai, Thailand where there is currently an epidemic of dengue fever.  It was hosted by a study abroad provider and course participants included a UN security officer, some researchers from Brunei, an aid worker from Myanmar and a number of study abroad practitioners. One of the host staff was just recovering from dengue fever and the director of the program and his whole family had had dengue in previous years. When surveyed, no one in the class was using insect repellent. “Preventative complacency comes with time, denial and the excuse of inconvenience” according to David Johnson the president of Wilderness Medical Associates. I would add peer perception to that. If you don’t see anyone else using bug dope then it must be ok not to use it. So effectively protecting students is more than just a matter of giving them the information.

Response Measures (what to do if you think you may have an infection)

Knowing what the vector disease exposures are, trip leaders should also have some idea of how they will respond if a staff or student becomes ill. Certainly no one would expect non-medical professionals to make a diagnosis of a vector-borne illness and the symptoms of most vector-borne diseases are similar to flu, but programs need to have identified acceptable medical facilities to bring their students to in the event of illness. It helps a lot if program staff have more than just CPR training under their belts and every program should have a medical professional available who has some understanding of travel and tropical medicine, of the medical infrastructure of low income countries and also is very familiar with U.S. standard of medical care. Some schools utilize a travel assistance provider. Some have an advisory physician who works at their school or is on their board. Some schools build a relationship with a travel clinic.                                         

Health, safety and security strategy starts with understanding the Safety Matrix® (who/what/where/when/why/how and how long) of a particular program. By the time a group departs to begin a program, you want a strategy in place that you can feel confident about. How do you know if your strategy is sound? If you can easily articulate why you did what you did and why you didn’t do what you didn’t do, and you wouldn’t second guess your choices even if someone did contract a vector-borne disease, then you likely have a robust plan in place.

Keeping informed in the social media age: How technology and intelligence platforms can help keep your students safe

In the social media age, news travels fast – very fast. Twenty years ago, the internet was still in its infancy and social media was non-existent. Today, the average parent of a study abroad student, with discretionary time and a computer, can locate an extraordinary amount of information about the hazard landscape of their child’s destination country. You can also be sure if a safety or security incident happens, Facebook, Instagram and Twitter will inform them instantly.

Given the ease with which people around the world can communicate and access knowledge now, both parents and students expect that the administration is keeping tabs on their overseas programs and that if there is a problem, the administration is aware of it immediately. So how do program administrators keep up with all of the important news that is relevant to every country in which their students are traveling, particularly given the laser-fast pace that social media spreads a story?

There are a several ways to manage your intelligence information. A number of travel assistance providers offer risk assessments and breaking news updates. Additionally, some may partner with security information services. For example, International SOS works with ControlRisks. Another option is to purchase a stand-alone intelligence platform. Finally, there are some easy ways to put together a DIY option using a variety of free and open source platforms.

If your institution is operating programs in a wide number of countries and regions, one solution may be an intelligence monitoring platform, such as Global Momentum or red24. Such platforms contain up-to-date, extensive information about health, safety and security around the world. Both companies have large and experienced global teams of analysts and sophisticated data mining technology that produces comprehensive – and constantly updated – news feeds that highlight new and evolving risks around the world.

Both Global Momentum* and red24 can also be customized so that you only receive information relevant to the regions in which your programs operate. The Global Momentum platform is particularly user-friendly and easy to browse quickly, with three display modes to view information. Their “24x7 Risk Monitoring Dashboard” provides updated news feeds from around the world, the “Crisis Incident Map” shows how events are unfolding in space and time, and the “Real-time Situation Room” provides breaking news, social media feeds and other intel on any particular critical incident.

Global Momentum and red24 also provide breaking news alerts, as well as daily and monthly overview emails of incidents that may affect travelers. In addition, red24 is the intelligence partner for Terra Dotta’s new Alert Traveler app, which not only provides country intelligence to administrators, leaders and students but also can send real-time alerts and allow students to check-in. Watch out for our review of this and other safety apps in our next newsletter!

If your program is large and travels to diverse regions, one of these platforms may be a very worthwhile investment, but if your budget cannot stretch this far, or if you operate in just a few, lower-risk countries, you might be able to set up your own low-tech monitoring system for free. This type of solution won’t give you the speed and in-depth analysis of a professional monitoring system, and it will take more time and effort, but it’s certainly better than not doing any information acquisition at all. Here are some tools that may help you set up your own monitoring system:

·       Symbaloo – This free app allows you to create your own dashboard/homepage. In addition, it allows for multiple tabs to further narrow the scope of information monitoring for easy access to information that may be relevant to your programs. For example, you might add local news channels for each region, weather forecasts, RSS feeds, twitter feeds, and other sources of local health, safety and security information that you can quickly browse to keep abreast of news and incidents. Although it takes a bit to set up, particularly because of all the pre-loaded links that need to be deleted, it is worth the effort.

·       Emergency and Disaster Information Service (EDIS) is a platform based out of Hungary which provides a map of the world to monitor global events that may cause emergencies and disasters. It is powered by GoogleMaps and sourced through information in the knowledge database, automatically processed data and manually processed data. It allows the user to choose a region or simply zoom in on different locations. EDIS also has Facebook, LinkedIn and Twitter links for easy monitoring.

·       Weather alerts – Some countries offer SMS or email alerts for extreme weather events. Try googling the local meteorological service and see if they offer such a service where your programs are located.

·       Google alerts – You can set up a google alert to be notified via email when a certain search term appears in the news. This is a slightly tricky tool to use to monitor news for a whole country generally, but if you can limit the search to a particular risk (say, hurricanes) then this might be useful, particularly for lower profile incidents that may not have yet made global news.

·       RSS Feeds – You can set up your RSS reader to include news sources and information feeds for areas of interest relevant to your programs. For a handy guide to RSS reader apps, here is an article from Zapier.

*Lodestone Safety International is partnering with Global Momentum and can provide a free trial. If you are interested, please contact Lodestone directly at info@lodestonesafety.com.

How to Make Safety Reviews Work for You

A safety review should reduce the likelihood of harm to participants, staff and property; serve as a vehicle for stakeholder education and improved institutional alignment; demonstrate a commitment to due diligence in safety; and boost morale among staff.

So why do many reviews, embarked upon with expansive optimism and openness, conclude with contention between reviewers and reviewed; real potential for increased future liability exposure; a demoralized staff; and program managers who regret having the review undertaken in the first place?

Safety reviews can have tremendous benefit, but they are not without risk. And usually, when reviews realize more risk than benefit, it is for the same recurrent reasons. And, an experience of a poorly managed review is one reason why program managers often prefer to avoid them.

International NGOs, international service/education programs, adventure education, sail training programs, etc. all share the challenge of operating with limited time, money and personnel. Sometimes one of the most compelling reasons to have a review is to get outside expertise to gauge the impact of the deferred maintenance and other compromises that are an adaptive effort to operate in the face of limited resources. However, it is also true that safety reviews require time, money and personnel, which is another reason why program managers can be unenthusiastic about undertaking a safety review.

However, the primary risk associated with having a safety review is the potential for increasing your liability exposure. Anything that appears in a report is discoverable should your institution be involved in a future lawsuit. It would not be in the organization’s interests should that report include unrealistic recommendations for unbudgeted expenditures; or damning statements about the program. A whitewash of safety issues is in no one’s interest either. Where you want to end up is with realistic, constructive feedback on your program with practical recommendations that translate into actionable plans.

The key to having a robust, productive process is understanding the various components of a review and being aware of the potential pitfalls within each:

            Goals – Realistically, what do you want to have happen during the review and what do you want the impact to be on your organization? Making your program “safe” is not a realistic option. Identifying opportunities to reduce the likelihood of harm is. Equally important is to identify what you do not want to have happen. Safety reviews look at the edges of an organization’s limitations. It is important to avoid having the review become the focus of all organizational conflicts. If you are not explicit about what the goals are and are not, then every agenda will find a purpose for the review to serve.

            Process – This is about deciding who will participate at what level and in what role. It is about how communication will be managed. Foresight and clarity at this stage are important. At the outset there is an impulse to commit to full transparency and participation. However, assume unforeseen sensitive issues will surface. It is preferable that the process become more expansive in its openness and inclusiveness as it progresses rather than heading in the other direction. It is recommended that early decisions about who is invited to participate at various levels; who gets to see the final report, etc. are conservative. This is about setting expectations. Be strategic.

            The Review Team – Having someone poke around in your organization second guessing decisions and evaluating performance is an intimate process and should be treated as such. While a review team should include outside parties, you need to have trust in the team. Hiring your friends is a little too cozy. Including board members can be excellent on a number of fronts but they can also be problematic. The team not only needs to have within its members the appropriate level of technical expertise, but should also contain sufficient administrative experience to appreciate the challenges of making decisions within budgetary limitations. One common mistake is setting up the review team to think that they need to document every aspect of safety or their integrity will be compromised in the discharging of their duties. The review team’s mission should be addressed in the goals and the scope. Communication and clarity are important. Roles, goals and process need to be explicit. The safety review works for the program and executes according to stated goals and scope.

            Scope – You may know exactly what issues you’d like addressed in the review. However, there are a number of ways to identify all the issues that your stakeholders view as important. A simple surveying tool can be distributed to field staff, admin staff and/or board members. Participant evaluations should be reviewed. Incident reports, end of program reports, etc can all be mined for input. Keep in mind that investigations of significant incidents rarely identify one poor decision or action as being responsible for the incident. More usually, it is a combination of events from multiple levels of an organization. Once you have a broad based list of potential issues, then you can make choices for putting together a productive strategy.

            Plan and Review – The specific plan for review should be defined by the scope and be consistent with your goals. Field staff and administrative staff interviews, document reviews, program observation, infrastructure and site inspections, etc. should be assigned to specific reviewers and executed.

            Debrief – This stage of the review may be particularly sensitive. Deciding who is invited to participate should be thought through accordingly. Reviewers should bring up for discussion all their observations, and analysis. They should share the rumors they’ve heard and their subjective impressions. Reviewers may share their ideas for solutions well beyond what should appear in the report. Everything useful may be discussed. In the course of this meeting, the shape of the safety report should be agreed upon between the review team and the program. One potential way to help encourage the frankness of the discussion without creating discoverable documentation of sensitive issues is to stipulate that all review notes be handwritten and destroyed once the written review is finalized.

            Report – The written report should reflect the stated goals and scope. It should document the goals, the process, the review team, the scope and the specifics of the review. It should then report its conclusions and recommendations. It is not in the organization’s interest to have unrealistically expensive and unbudgeted recommendations made, nor to have damning observations committed to print. It should include the program’s observed strengths as well as providing direction for changes. What is working well? What are the easy steps? What are the more challenging issues and the longer term, multiple front strategies? Recommendations should be general. There are occasions, most usually having to do with personnel and financial issues, when it may be appropriate and useful to have an additional confidential report prepared for the board or some subset of stakeholders.

            Report Response – The organization should document a formal response to the review summarizing the organization’s experience of the review and indicating degrees of agreement (strongly agree, agree, disagree, strongly disagree) with each specific conclusion and recommendation. Where there is agreement, the general implementation strategies should be included. Where there is disagreement, the rationale should be spelled out clearly. Any additional strategic moves resulting from the review should also be included here.

            Safety Plan – To maximize the benefit of the review, the organization should create a safety plan based on the review. It may vary from the reviewers’ recommendations and it may exceed the scope of the review. For each aspect of the plan, there should be a designated point person, a time frame and criteria for completion. Periodic reviews of the safety plan should be scheduled in as well.

Safety reviews should be an invaluable tool for any program. Maximizing the benefits and minimizing the risks is a matter of awareness, forethought and attention especially early on in the planning process. If you manage the details well early on, the rest of the process should unfold in a manner that helps your organization do what it does in a more effective, professional and safer manner.  It should also assist in building a stronger more integrated organizational culture with a heightened awareness of health, safety and security.

You want to go WHERE? You want to do WHAT? Risk Managment Challenges in Non-traditional Locations

by Adam Rubin

When I first started in the field of international education many years ago, international educators often lamented the fact that the vast majority of their students limited their study abroad choices to the United Kingdom, France, Spain, Italy, and other traditional destinations.  Thanks to the development of new program models and an increased spirit of global adventure, it has now become quite common for students to seek study abroad opportunities in less traditional parts of the world.  For some students, these destinations offer a chance to get off the beaten path to explore environmental issues, participate in meaningful service-learning projects, or develop stronger language skills.  For others, less traditional locations help a student experience new political perspectives, step outside their comfort zone, and do something “unique” that will help them stand out from the crowd in future job interviews.  The rapid expansion of international programs over the past ten years has been truly exciting and wonderful in many ways, and study abroad professionals are now celebrating the fact that nearly 40% of U.S. college students studying abroad in 2014-15 went to non-European destinations.[1]

At the same time, it’s important for educators to understand that non-traditional destinations often require additional planning and special attention to potential risks.  While we all acknowledge that there are inherent risks involved with any domestic or international program, institutions and individuals should devote extra time and consideration to the challenges involved with international programs in low and medium income countries, programs operating in remote locations, and programs in politically-unstable regions.  Here are just a few key areas and questions that should be considered:

●       Emergency Contingency Plans

○       What are your specific triggers for program changes, suspension, cancellation, or evacuation?  Do you have proper Political Evacuation and Natural Disaster (PEND) insurance?  Do you know how it works?

○       Have you trained your staff to manage emergencies?  Have your contingency plans been practiced and reviewed?

○       Does your plan include academic contingencies associated with program disruption or cancellation?

●       Health and Mental Health Infrastructure

○       Have you done a proper assessment of local hospitals and clinics?  Do you have access to appropriate facilities when your group is traveling outside of the host city?

○       What is the state of mental health care in your host city/country? Are there English-speaking counselors readily available?  Are psychotropic medications legal in the host country?  How might those medications interact with other necessary medications such as malaria prophylaxis?

○       Are there specific issues, conditions, or challenges that should be given extra consideration when screening students for your program in this location?

●       Transportation Providers

○       What are the safest modes of transportation available to your program? Have your local transportation service providers been carefully vetted?

○       Have you carefully prepared a list of vetted and recommended transportation options for students to use during their daily commute and independent travel?

○       How might the local infrastructure impact your program’s overall schedule and content?

●       Unstructured/Free Time for Students

○       How can your program monitor independent student travel? Does it make specific recommendations to students regarding transportation, accommodations, and security?

○       What are some of the local high risk activities that might attract students? (bungee jumping, surfing, swimming, sky diving)? How can you manage those risks? Can and should certain activities be prohibited on your program?

○       Does your program conduct a bystander intervention training workshop during orientation?

●       Program Leadership

○       Do you have appropriately-trained staff to lead your programs in these locations?

○       Have you vetted the staff used by partner institutions (i.e. host university) or local service providers to help ensure that they are qualified and competent enough to support your program adequately?

○       Who is going to answer the phone at 2:00 a.m.?

●       Program Housing

○       How are local homestay families screened and trained? How do cultural issues impact your ability to screen local families?

○       How might concerns about fire safety, security, and local environmental issues impact your selection of program housing (residence halls, homestays, hotels, hostels)?

While these are all important issues and questions that should go into the risk management planning for any domestic or foreign student program, they become increasingly important for programs in low or medium income countries, locations with specific environmental or political challenges, and programs that include significant fieldwork and travel in remote locations.  By taking the extra time to plan carefully, you and your team will be better prepared to assess, manage, and mitigate risk.  And, you’ll be in a much better position to respond confidently when parents, senior school officials, and institutional risk managers question you about the overall safety of your programs. 

[1] Institute of International Education. (2016). Open Doors Report on International Educational Exchange. Retrieved from http://www.iie.org/opendoors

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Adam Rubin has worked in the field of international education for over 25 years, including more than 20 years with the Council on International Educational Exchange (CIEE). He is the former Executive Director for Program Development and Evaluation at CIEE and also served as Senior Program Director for programs in Africa, Asia Pacific, and the Middle East, Director of Campus Relations, and Resident Director of the CIEE Study Center in Japan. Adam is a member of the NAFSA Trainer Corps, former member of the NAFSA Health and Safety Subcommittee, and a member of the Forum on Education Abroad Standards Committee. He served for two years as a member of the planning committee for the Forum Standards of Good Practice Institute, “Beyond the Basics of Health, Safety, and Security.” Adam also served as a board member for the World Affairs Council of Maine. He has presented nationally and internationally on a variety of issues and topics, including program development, health, safety, and security issues, community engagement, and developing and managing programs in non-traditional locations. Adam received his MA in East Asian Studies from Stanford University and a BA in Economics from Whitman College.