Go Global with Kate Yapp: Navigating Health Challenges While Studying Abroad

By Kate Yapp

Having disabilities and/or health conditions doesn’t mean that you can’t or shouldn’t go abroad. I spoke to several students who have studied abroad with disabilities or other health conditions, and they were willing to share their experiences and provide tips for people in similar situations who are thinking about traveling.

One such student, Naomi Stewart ‘23 (English), studied abroad by directly enrolling at Queen’s University Belfast in Northern Ireland through the program Arcadia.

Stewart didn’t know if she would be able to study abroad because she lives with Ehlers-Danlos Syndrome (EDS) which causes pain all over her body (especially in her joints). She also deals with chronic migraines and headaches, Mast Cell Activation Syndrome (MCAS) and Postural Orthostatic Tachycardia Syndrome (POTS).

While she is able to manage symptoms in the U.S. like pain, inflammation, headaches, muscle spasms, severe brain fog and more, Stewart was unsure how she would be able to do the same while abroad, especially because, as Stewart found, “It takes much longer to get an appointment with healthcare providers in the U.K. than in the U.S.”

Stewart said she didn’t realize how much the weather would affect her body. “It rained almost every day, which made my headaches a lot worse along with my joint aches.” And while she was able to check out some cool historical sites, like the Tower of London, wheelchair access was limited in the places she visited. “There are often elevators or ramps in buildings but the road and sidewalks are so old and bumpy that many of the people I knew who used wheelchairs were limited in where they could go.”

While Stewart said her disability is “invisible” compared to someone with visible aids like a wheelchair or hearing aids, she still found it hard to fit in at first. Some of her peers didn’t understand why she wouldn’t engage in common bonding activities like clubbing, which is popular in the U.K. (and Europe as a whole). They didn’t know that, as Stewart puts it, her body is “not made for clubbing.” Stewart was often exhausted from the day by 8 p.m., and the strobing lights and loud music led to headaches, which she already suffers from.

Stewart said that the people who were offended when she rejected their offers to go partying typically didn’t spend the time getting to know why she said no in the first place. But eventually she found her people. Stewart emphasized that the best way you can support your peers with disabilities and severe health conditions while studying abroad is to “check in, make sure you help when they ask for assistance, lend a listening ear and slow down when they are running out of spoons.”

The spoon theory is often used in disability and health circles to describe the limited energy everyone has in a day to take care of themselves, achieve tasks and engage in activities. Sometimes people with disabilities and severe health conditions have less spoons because their symptoms can wear them out or because certain tasks are harder for their body and mind.

Stewart acknowledged, “Many struggles can be the same for all students abroad, like the fear of leaving home, entering the unknown, a new culture, etc. But at the same time, those with disabilities have an added and extra challenge. Usually, at least, I already live in the unknown as I don’t always know what my body will do. So when all that I know about my environment is taken away, it won’t just be my brain that is overwhelmed. It will be my body, too.”

For other Katies with health challenges who are interested in studying abroad, Stewart said, “Don’t be afraid to be different, especially when it comes to the health of your body. I really had to learn this while abroad as I would go on trips with friends and would have to nap or slow down as I was running out of spoons, and usually, they were good with it, but sometimes if I was with new people they would stare or glare when I left and then wouldn’t speak to me the next time. While it hurts to be misunderstood, rest was what I needed to enjoy my time while abroad.”

And with all of the preparation and planning that goes into studying abroad, the most important thing is that you feel like you get what you want out of it and not that you’re fulfilling anyone else’s expectations. Stewart is ultimately glad she went abroad: “It was challenging, but I don’t regret it. I had the time of my life in Belfast and plan to apply to graduate school there.”

Naomi Stewart traveling while studying abroad

When deciding if studying abroad was a possibility to begin with, Stewart consulted with her health team and felt confident when she got their approval and made a plan to acquire access to all of the medications she would need while overseas.

“While I wanted to go abroad regardless, I also wanted to make sure that I could sustain a healthy body while abroad. My team felt that this was something that I could do but that I should know that there would be risks and unknowns.”

Stewart lamented that for people with disabilities and extra health concerns, there will always be more paperwork. Stewart had to fill out forms with Queen’s University and Arcadia in addition to with St. Kate’s. Stewart noted that something all students who need accommodations should keep in mind is obtaining a current note from their primary doctor (or equivalent) stating that they are able to go abroad and what specific accommodations they require.

On the bright side, Stewart found that Queen’s University and Arcadia were fairly responsive when she communicated her needs. They fought alongside Stewart to make sure she got the accommodations she requested, like comfortable housing and flexible attendance. Throughout the semester, she appreciated a lovely Arcadia staff woman who would message and call Stewart “just to check in and see how I was doing in both my mind and body and ask if there was anything she could do. I felt very supported there.”

Stewart recognized, “At the end of the day, after all of my accommodations were made, it was still very intimidating to go abroad as I had no idea how my body would react. In my head, I could predict, but as I had not studied abroad before, I could not know, which was scary.” But she wants other Katies to not be discouraged or turned off from exploring places beyond 2004 Randolph Ave.

“I wanted to go [abroad] so badly and it was so hard to get there. The paperwork, the medication preparation, the mind and body preparation — it was a lot of work to get there, but it was so worth it. I loved being in Ireland and seeing another part of the world.”

Abigail Nachreiner ‘24 (Economics, Public Policy and Women and International Development) was actually with me on the 2023 GSJ Women and Work in India course trip.

She chose to do a J-term experience because “studying abroad was something I was interested in, but doing a whole semester abroad just didn’t seem practical for me and my needs.”

Abigail Nachreiner and the author in Jaipur India with two other students from the GSJ Women and Work in India trip

Nachreiner struggles with dysautonomia, which affects the autonomic nervous system. It is challenging because the autonomic nervous system controls your autonomic bodily functions like breathing, heart rate, blood pressure, body temperature, etc. As a result, Nachreiner easily gets dizzy and out of breath and frequently overheats. She also deals with joint pain, “which can make it difficult to walk long distances or stand for an extended period of time.”

Before going on the trip, Nachreiner was diligent in asking lots of questions and getting her concerns addressed by the Office of Global Studies. “I wanted to know how physically demanding it would be.”

She then met with her doctor and the travel clinic on campus. “My primary care doctor wrote me a note that she thought I was capable and healthy enough to go on the trip. We made sure I knew what to do in case anything were to happen while I was abroad. This included me knowing my treatment plans and having all the rescue medications (and updated prescriptions for regular medications) I would need in India.”

“I still had anxiety that I wouldn’t be able to keep up or that people would be judgemental, but I also realized that those shouldn’t be reasons to stop me,” Nachreiner said. “I think not going alone really helped with these anxieties too. Knowing I would have people there to support me was reassuring.”

Nachreiner was well acquainted with the professors leading the trip, Dr. Deep Shikha and Dr. Kristine West. “They [Shikha and West] made sure I was included in everything,” Nachreiner said. “At some of the places we visited, they made sure a wheelchair was available so I didn’t have to worry about getting too fatigued throughout a tour.”

Abigail Nachreiner in front of the Taj Mahal in India

“It was a lot of walking. I used my cane though and that helped. The professors and tour guides also made sure I had time to sit when possible and I was allowed to stay back if I needed to. There were a few nights where I couldn’t make it to supper or needed to take the afternoon off. They made sure I got something to eat. Taking breaks really helped.”

Nachreiner was also pleasantly surprised by how she was treated in India in regard to her disability.

“I didn’t know what the reactions would be outside of the U.S. I didn’t expect people to be so accommodating. For the most part, everyone was very kind. It was a little strange to have people frequently asking what was wrong with me, but after talking to our tour guides about cultural norms in India regarding disability, I realized everyone just wanted to help. They wanted to know what was wrong so they could make suggestions on where I should go to get help or remedies they had tried that worked.”

Abigail Nachreiner being pushed in a wheelchair to make her visit to Amber Palace in Jaipur India more accessible

Nachreiner was happy with her decision to go on the GSJ trip to India. She recommends a J-term study abroad experience for Katies with health challenges “if everything is stable and you are able to manage things on your own for a couple weeks.”

Nachreiner also echoed Stewart’s sentiments when it came to how Katies can best help their peers who struggle with some of these same things. “Be supportive. Traveling can be stressful for people with disabilities, especially when they’re traveling to places that don’t have the best accessibility. Check in to see if they’re doing okay. I know I can have a hard time saying I need a break. The one big thing that I think really helped me was my friends being okay with the fact that I needed to go slower. They were okay going at my pace which made me feel like I wasn’t a burden or hindering their experience.”

Julia Handley ‘23 (English, Language Studies and Spanish minors), is a Katie with a heart condition, asthma and scoliosis. She opted not to study abroad during her undergraduate education but has some tips from personal travels that might be helpful:

If you are thinking about doing a study abroad program, talk to your doctors right away. They can help you make an educated decision and weigh the risks as well as connect you with resources and help you make a plan.

Talk to your family and make a plan in case a situation does arise when you would need extreme medical care or treatment. Look into an advanced medical directive.

Plan an itinerary with plenty of downtime to rest and relax

Ex. Do something like a hike in the morning and then make [cocoa] and play games or go for a drive in the afternoon

Be mindful of when you travel to a location and the weather at that time of year

Ex. Go to Florida in March or November

Considering taking a bus/car or flying

Will you need to get up and stretch and walk around? (Ex. To prevent blood clots)

Can you handle a layover/being in a cramped flight or do you need a shorter flight?

Will you be able to pack the supplies you need?

Your medical equipment like a CPAP machine or medication or scoliosis brace as extra luggage does not count as your personal item or your checked item.

Airport security is not always disability friendly (especially if you have a medical device like a scoliosis brace or rods in your leg. Pacemakers can also be a risk so let security know.)
Do you have a service animal? What will be best for the animal?
Reserve seats ahead of time

Do you need to be on an aisle?

If you have a mobility device, let the airline know ahead of time. U.S. airlines are pretty good at helping you get around with a cart or wheelchair through the airport to your gate.
Most rental car companies have adaptive vehicles if you call 48 hours in advance

Just because something is over the counter in the U.S. or not requiring a prescription, does not mean it will be easy to find or available where you travel

Keep medications in original containers and in your personal item so you don’t risk them getting lost.
If you leave your hotel, put your medication, like a controlled substance, in the hotel safe. You can also buy portable safes.
Think about what first aid equipment you need that other people might not (Ex. heating pack, ice pack, brace, ace bandages, tiger balm, a pulse oximeter, thermometer, glucose tabs, etc.)

Look into good hospitals where you will be traveling, particularly if you are spending a larger amount of time there like a semester.

You might be better off if something comes up in a large city, like a capital

Look into places where English is commonly spoken if you are concerned about a language barrier when receiving medical care and what translation services these hospitals have
Make sure your program provider and host family or roommates know of your medical conditions and are capable and/or willing to support you
Carry around a card with you in your wallet or on your person that has a brief description of your medical conditions, what medications you take and allergies you have so anyone giving you medical care can know what might affect your outcomes and treatment.

Consider having it translated if you are going to a different country.

Check to see what you might encounter in this place that would interact unsuccessfully with your medications or body like foods, drinks or environmental factors.

Ex. Lots of food in Asia is cooked in peanut oil, France uses a lot of dairy products with few non dairy alternatives, it’s relatively easy to be vegetarian in India, etc.
Learn how different countries denote different allergens and ingredients. (Ex. In the Czech Republic, allergens are given a number 1-7 and marked on menus and food containers)
Learn the different words for allergens in the language of where you are going so you can ask about them at restaurants and at meals.

You may have to be prepared to spend more on things you need, like Ubers or another pillow to be comfortable, reusable ice packs, heating pack

Last thoughts: Advocate for yourself to make sure that all of your accommodations are respected and met, and don’t forget to accommodate yourself in the ways that you can.

And if international travel seems daunting but you still want an “away” experience during college, you can check out my article about exchange possibilities at other U.S. colleges in the CSJ consortium.