Health and Safety

Physical Health

Traveling to a new place can take a toll as a person’s body works to adjust to their environment. Even if a participant is normally very healthy, they may become sick while abroad due to the stress of living in a new place and exposure to new bacteria and viruses. Stomach ailments and the flu are some of the most common illnesses that CLS participants experience abroad. To help prevent illness, participants should do their best to stay hydrated and maintain a healthy diet and sleep habits throughout the program. If a participant becomes sick or does not feel well, they should contact their Resident Director, who can provide information about local pharmacies and health clinics or hospitals. The choice of where to receive treatment and which treatment(s) to receive are at the discretion of the participant. The Resident Director and/or local staff are able to accompany participants to a clinic or hospital upon request.

Paying for Medical Care Abroad

CLS participants are strongly encouraged to maintain coverage by a primary U.S health insurance policy for the duration of the CLS Program. The regular health coverage of participants is supplemented by limited emergency and accident medical coverage from the Accident and Sickness Program for Exchanges (ASPE), provided by the Bureau of Educational and Cultural Affairs of the U.S. Department of State. Information about ASPE is provided to finalists as a part of pre-program orientation.

ASPE works primarily on a reimbursement basis. If a CLS participant receives medical care abroad that incurs a cost, the participant is typically expected to pay for the treatment and any prescription medications out of pocket. Participants should be prepared to pay up to $500 in medical expenses up front. After paying for the treatment and receiving a receipt, the participant may submit a claim for reimbursement. Students should keep receipts for any medical treatment or prescription medications purchased abroad until they return to the U.S. Participants are expected to manage their claim(s) directly.

Mental and Emotional Health

Adjusting to a new environment can significantly impact one’s mental and emotional health. Jet lag, changes in diet, new or different sensory inputs, the stresses of academic study, and navigating group dynamics and cultural differences are just some of the elements that can affect participants’ mental and emotional state while abroad. While these factors can influence the well-being of participants with pre-existing mental health conditions, students without mental health conditions may find themselves struggling for the first time.

Participants are urged to take time to reflect on and process their experiences and emotions throughout their time abroad. Some students benefit from speaking about their experiences with others, while others find that writing, creating music or art, or taking a walk can help them process their thoughts. Maintaining a consistent sleep schedule, eating healthy, and staying active and hydrated also support participants’ mental and emotional well-being.

If a student finds that they are struggling with mental health, they are encouraged to reach out to their Resident Director or host institute staff as soon as possible. CLS staff are not medical or mental healthcare providers, and they are not able to provide therapy or counseling services. However, CLS staff can listen to a participant, brainstorm ideas for implementing behaviors that may better support a participant’s emotional well-being, and share information with the student about mental health resources that are available in the host community, if any such resources are available. Mental health specialists and counselors may not be available in the host community, may have limited or no English language skills, or may approach treatment using significantly different methods compared to what is common in the U.S.

Participants can access the following resources at any time:

• ASPE Assist: ASPE Assist is a 24-hour crisis support hotline. The professional staff who respond to calls are trained to assist individuals abroad experiencing serious situations such as mental health crises. Contact information for ASPE Assist is provided to CLS finalists during pre-program orientation.
• National Suicide and Crisis Lifeline: The National Suicide and Crisis Lifeline provides free and confidential support to callers experiencing emotional distress and crisis situations. The Lifeline can be reached by dialing 988 in the U.S. or +1-800-273-8255 while abroad (international calling charges likely apply). The Lifeline is also accessible by chat at https://988lifeline.org/chat/.

In some cases, participants may also be able to connect with their home institution’s mental health services office or a mental health provider they have worked with prior to the CLS Program. It is helpful to explore the availability of these resource prior to departure so that if a participant needs support during the program they already have the details and contact information available on hand.

Cultural Adjustment

When a person travels to a new place, they bring with them their values, patterns of behavior, and understandings about what is “good” and “bad” or “normal” and “abnormal”. Values, patterns of behavior, and understandings of everyday occurrences in the host community are often different from what participants are used to. Some differences are easy to observe, such as traffic patterns or the way buildings or stores look. Others can be harder to observe and may pop up at unexpected times in everyday interactions.

Culture shock is a term often used to describe the discomfort people feel as they adjust to life in a new setting with different values, patterns of behavior, and expectations. It is a natural part of learning a new culture and adjusting to a different place, and nearly everyone experiences it. Feelings associated with culture shock can include extreme homesickness, physical complaints and sleep disturbances, frustration or annoyance, depression or anxiety, loss of sense of humor, boredom or fatigue, difficulty with coursework and concentration, the feeling that one’s language skills have grown worse on the program, or hostility toward the host culture.

Participants are encouraged to talk with their Resident Director, teachers, institute staff, Language Partner(s), CLS peers, and host family or roommate about things they do not understand or find frustrating about the host culture. People who have experience living in both the United States and abroad are also excellent resources for participants to process feelings of culture shock, including CLS alumni.

Here are some other useful strategies that can help participants adjust to the host community culture:

• Set reasonable goals and expectations, particularly at the beginning.
• Plan small tasks each day that will help you meet people and accomplish something, like preparing a new food or visiting a new part of the city.
• Find a friend from the host community who can help “translate” the culture.
• Pay attention to your body: eat properly, exercise, and get plenty of rest. The CLS Program is tiring, and a good night's sleep will help you to recharge.
• Don’t isolate yourself – try to be social, even when you may not feel like it. Take the initiative and invite your cohort members to study or explore the host community with you.
• If there is a hobby or activity you enjoy doing back home, try doing it in the host community if appropriate.
• Remember that it is normal to feel overwhelmed, but also that your ability to cope with cultural differences will strengthen over time.

If a participant feels depressed or the feelings of homesickness do not go away, they are urged to speak with their Resident Director as soon as possible or to reach out to another resource, such as those described in the “Mental and Emotional Health” section above.

Crime and Personal Security

The CLS Program takes participant safety very seriously and works closely with the U.S. Department of State and U.S. Embassies and Consulates to evaluate CLS program sites and review safety considerations before and during the program. All CLS Program participants are registered with the U.S. Embassy or Consulate overseas in advance of departure through the U.S. Department of State’s Smart Traveler Enrollment Program (STEP), which facilitates communication if the U.S. Embassy or Consulate needs to contact U.S. citizens in the host country or location with an important announcement.

Countries where the CLS Program operates may experience economic, political, or social uncertainty. In this context, participants’ status as foreigners can attract unwanted attention and have potential consequences for personal safety. The intention of CLS staff is not to frighten participants but to make sure they have basic information to decrease their likelihood of experiencing crime. Some considerations for participants’ safety are listed below. More information about safety and security in the host community is provided during the pre-program and on-site orientations.

Lowering One’s Profile

• Observe interactions between members of the host community and talk with your Resident Director, host family, roommate(s), or Language Partner(s) about culturally appropriate behavior that may help to lower your profile as a foreigner.
• Dress appropriately for the local culture and avoid clothing that may be interpreted as provocative or makes you stand out as a foreigner. Although foreigners are often considered “exempt” from local societal norms of dress, it is important to communicate respect by abiding by the local dress culture, which will also help you lower your profile.
• Consider which language you are speaking when out and about and the volume of your voice. Speaking loudly in English often attracts attention.

Out & About

• Walking or traveling with a friend or in a small group can be safer than traveling alone or with a large group. Walking with someone else helps deflect approaches by people who might bother you.
• Do not walk alone at night. If you visit friends in the evening, ask them to escort you home or remain with you until you are in a taxi.
• Always take licensed taxis.
• Always tell someone, such as friends or your host family, where you are going and when you expect to return.
• If you want to visit a new neighborhood, make your first visit during the day. Look at a map and note the nearest sources of public transportation and routes. Discuss the safety of the neighborhood or area with CLS institute staff and other members of the host community, such as your Language Partner(s) or host family.
• When asking for directions, use common sense and approach people who seem non-threatening. It is best to ask a family group or an individual of the same gender as you for directions. Please note that in some cultures, it is not considered appropriate for a man to approach a single woman for directions. CLS staff discuss culturally appropriate interactions during pre-program orientation.

Avoiding Theft and Petty Crime

• Be aware of bag-snatching, pick-pocketing, and other theft, even in broad daylight and especially in busy marketplaces and tourist areas. Wallets in the back pocket of your pants or backpack are an attractive target. Keep your bags zipped and close to your person, either under your arm or in front of you.
• Backpacks are not recommended for use on crowded public transportation. If you do carry a backpack, hold it in front of you or over one shoulder to ensure that you can see it at all times.
• A concealed money belt is a good option in crowded situations. Be sure to take out money you might need ahead of time.
• Avoid carrying large bags during travel, when possible, as it could draw attention and attract pickpockets.
• Be vigilant in restaurants, hotel lobbies, train compartments, airports, and train stations. Be wary of con artists, distractions, and diversions.
• Talk to your host family and local staff about safety. Your safety is their priority, and they may be able to give you more detailed information about areas to avoid.
• Practice situational awareness. Be aware of what is going on around you at all times, and be prepared to cross the street or take an alternate route to avoid unwanted attention.

Money Safety

• Do not handle or display large quantities of money on the street. Only take out the amount of money that you need for a given transaction.
• Be discreet with credit cards, jewelry, laptops and smart phones. Once you have obtained local currency, you probably won’t need to carry your credit/debit card every day. Be smart about what you carry with you when out and about in your host community.
• Never carry more money than you immediately need. If you need to carry substantial amounts of money, consider wearing it under your clothes in a concealed money belt or pouch.
• In your CLS housing, lock your money and debit/credit cards in a suitcase in your room, and be discreet with money around your host family or roommate(s). Even if you trust them, you may not be able to trust visitors or workers they may have over while you are out. Bring a luggage lock so you will be able to secure your valuables or private belongings.

Exchanging Money and Withdrawing Money from an ATM

There are many safe locations where participants can legally exchange money. When exchanging money, participants should receive receipts and keep them until they return to the United States. Below are some additional tips for avoiding problems:

• Go with a friend when you exchange money or use an ATM.
• Avoid exchanging or withdrawing money when it is dark.
• Do not call attention to yourself by speaking loudly when dealing with money. Count your money before stepping away from the exchange counter. Calculate the exchange rate ahead of time and be sure you received the right amount of money.
• If you are traveling, withdraw any money you expect to need for your trip from an ATM before leaving so you won’t run the risk of losing your card in a malfunctioning ATM far from your host community.
• Do not use an ATM if you see that there are many scratch marks near the card insertion slot, or if the card insertion slot is loose or looks like it has been detached. Inspect the ATM for skimmer devices, which can look like pieces of tape or plastic attached to the machine.

Street Harassment

While street harassment can occur anywhere, it is a common problem in many CLS Program sites. Street harassment can be defined as acts of a sexual nature directed at a person in a public space without their consent. It can include, but is not limited to, catcalling, whistling, making comments of a sexual nature, sexual contact or groping, and/or pursuing someone on the street. As other forms of sexual misconduct, incidents of street harassment can cause harm and make a victim feel unsafe in their surroundings.

It is important to consider how to avoid situations that may become dangerous. CLS staff advise that participants avoid being out late at night by oneself and being alone with someone new. Participants should avoid some common mannerisms that are common among Americans but that can be read as a sexual invitation in many other cultures, including making eye contact with or smiling at strangers, especially strangers of the opposite sex.

Even when following safety advice, participants may still experience sexual harassment during the program. Regardless of the circumstances, people who experience sexual harassment are never responsible for the perpetrator’s behavior. The CLS Program is committed to supporting participants’ to safety in their host communities and providing support to participants who experience any form of sexual misconduct, including street harassment. During pre-program and on-site orientation, CLS staff share information about street harassment in the context of the host community and provide guidance on steps participants should take if they experience street harassment. Below are some strategies that can help when deciding how to respond to harassment:

• Oftentimes, the best response to unwanted stares, comments, or touches is to ignore the harasser and remove oneself from the situation quickly and calmly.
• Participants who are harassed or pursued by a stranger in public should remain in a public, visible, populated place and call their Resident Director immediately.
• Female-identifying participants may find it more comfortable to be in the company of a male-identifying participant or group while in public places.
• Participants should be supportive of one another. If a participant is among a group of CLS peers and notices that another participant is being targeted by street harassment, suggest that the group move elsewhere.

Even when following these tips, participants should understand that they are not responsible for the actions of others and that harassment is never the fault of the victim. For more information about the CLS Program’s policies on sexual misconduct and a list of resources available to those who experience sexual misconduct, participants are encouraged to review the Harassment and Sexual Misconduct section of this guide.

Transportation Safety

Traffic accidents are one of the most common causes of death and injury for U.S. citizens abroad and a major risk for study abroad participants. The CLS Program Terms & Conditions prohibit participants from driving or operating motorized vehicles of any kind in the host country/location. During the on-site orientation, participants receive information about the forms of transportation that are safer to take in the host community. In some host sites, there may be forms of transportation that participants are not permitted to use.

When traveling by licensed taxi, bus, or other forms of public transport, participants should pay attention to traffic patterns, alert the driver to any dangers, and consider getting off if the driver is behaving dangerously. Participants should also note all emergency exits in vehicles and insist on using seat belts if they are available, even if local people do not use them or if the driver discourages their use.

As pedestrians, participants should stay particularly alert and look both ways before crossing the street. In many parts of the world, pedestrians do not have the right-of-way, so participants should never assume a car will stop for them or steer out of the way. It is best to stay on sidewalks away from the curb and walk facing oncoming traffic whenever possible. Participants should also be aware that traffic lights may change the instant a pedestrian walk light changes, and there may not be lag time to allow the pedestrian to finish crossing the street. If a participant is not sure how much time remains to cross the street, they should wait for the next light cycle. Participants are encouraged to ask their host family, roommate, or Language Partner(s) for additional tips on navigating the host community more safely as a passenger and a pedestrian.

Water Safety

During the CLS Program there may be opportunities for participants to swim, go boating, or participate in other water-based activities. Any activity involving water carries risks, including drowning, injury, and water-borne illness. The safety precautions that participants may be used to in the United States, such as the presence of lifeguards, will likely not be present at the host site. Participants are strongly encouraged to carefully consider the risks of participating in water-based activities and follow common sense and safety guidelines to minimize the chances of water-related health issues or injuries.

Drowning

Drowning is a significant risk and is another major cause of death for U.S. citizens abroad. To reduce the risk of drowning, the CLS Program expects participants to adhere to the following safety measures:

• Assess your own comfort with water and your ability to swim.
• Approach all water with an abundance of caution.
• Only swim in designated areas.
• Never swim or go boating alone, always go with at least one other person.
• Do not swim or go boating at night.
• Do not consume alcohol before or during swimming or boating.
• Do not dive into unfamiliar or shallow water as the depth may not be obvious or marked and dangerous objects, such as rocks, may be present.
• If you have an opportunity to ride on a boat, use proper safety equipment such as life jackets.
• Beware of invisible dangers such as riptides and strong currents.
• Adhere to posted signs, including those that prohibit swimming in a specific area or note the absence of lifeguards.

Water Quality and Water-Borne Illness

In addition to drowning, partaking in water-based activities can also facilitate exposure to bacteria which may cause water-borne illness. Information outlining water quality may not be readily available in the host country/location. Before participating in any water-based activity, students should review the Centers for Disease Control and Prevention (CDC) destination page for health notices and specific information related to staying safe around water. Participants should also adhere to the following:

• Make sure you are aware of potential infections that may result from swimming or wading in the waters in your host community. For example, research whether schistosomiasis and leptospirosis are common in the region.
• Do not swallow water.
• Do not engage in water-based activities with open cuts or wounds.
• Consider potential pollutants that may be present in the water but may not be visible.

Other Water-Related Risks

In addition to the danger of drowning and illness, there are other risks associated with being in and near water. Participants should be aware of aquatic animals that may pose a risk in their area, such as sharks, jellyfish, water snakes, etc. They should also consider the risk of hypothermia, particularly if swimming or boating in mountainous areas or places where the water temperature may be colder than the air. It is also recommended to wear shoes with sturdy soles when walking on beaches or along waterways, since hazards such as broken glass, sea urchins, animal feces, and parasites may be present.

Heat Safety

Many CLS sites experience prolonged periods of intense heat and/or humidity in the summer. Consistently hot temperatures can take a toll on the human body in the form of dehydration, heat exhaustion, heat stroke, and other health risks. CLS-provided housing may not have air conditioning. Participants should take the following steps to cope with hot weather:

• Stay hydrated. Dehydration can cause dizziness, fatigue, and stomach issues and can have a negative effect on one’s mental health. Drink plenty of water, even if you do not feel thirsty, and make sure to bring a sufficient supply of water with you whenever going out. Drinking water is not enough, however; be sure to also frequently replenish electrolytes lost through perspiration by eating snacks or adding rehydration salts to your water.
• Be strategic about going outdoors. Do your best to avoid being outside during the hottest part of the day. If you exercise outdoors, consider doing so in the morning or evening, when temperatures are likely to be cooler. Identify local cafes, restaurants, libraries, and stores that use air conditioning and spend time there whenever possible, especially during heat waves.
• Protect yourself from the sun. When walking outside, stay in the shade as much as possible. Wear lightweight, loose-fitting clothing that provides coverage, as well as a sunhat and sunglasses, and apply sunscreen to any exposed areas regularly to reduce the risk of sunburn.
• Educate yourself on the symptoms of heat exhaustion and watch for them in yourself and others. If you feel ill, stop all activity, rest in a cool place, and drink cool beverages. You can also cool down by taking a shower or bath with cool water or applying a wet cloth to your skin. Rest regularly and avoid overexertion, as energy is depleted more quickly in hot temperatures.