Dear Dr. Spilchuk…
Should I Reveal My Health Condition?
Dear Dr. Spilchuk,
I have read your columns in ISR and find them interesting and helpful. I would like your opinion about applying for an international position as a teacher with a chronic, treatable condition. How much information should I share with any future employers about my condition?
This is an interesting question, and certainly an ethical one. For your information, in many locations you must provide a medical certificate declaring your state of health. This might include a full medical report from your personal physician including test results in a variety of requested areas such as HIV, Hepatitis, etc. Even if this were not so, I would disclose all pertinent medical information to a school I was applying to in the event that anything were to go wrong in the future. You do not want to be left high and dry somewhere and you certainly do not want an international experience to cost you your health…or worse.
Responses to This Column
We have had some interesting experiences with regards to medical conditions and overseas postings. Perhaps they might be of interest to ISR readers. Our son was diagnosed at a young age with a condition which is completely treatable and manageable with medication. This injectable medication however happens to be extremely expensive; expensive enough for it to be a deal breaker if a school’s insurance didn’t cover it; expensive enough to have required taking out a second mortgage on our house if insurance didn’t cover it. Our first experience with this challenge overseas was shortly after the diagnosis when we were on our way to rural Pakistan. When the company sponsoring the school found out that the insurance wasn’t going to cover it (pre-existing condition) they donated half the cost of the medication, covered the expenses of travel to Singapore for routine health check ups by a specialist (the closest we could find to Pakistan), provided us with a second refrigerator as the medicine needed to be kept refrigerated, and even had a generator ready for any extended power outages. Wow! If we hadn’t divulged this medical situation, we would have struggled a great deal more than we did.
A few years later we were offered another overseas teaching position. We had to know if insurance would cover the costs before we could accept and so were up front with our situation. The school was extremely helpful in connecting us with the school’s insurance representative and a local pediatrician to make sure that adequate care, as well as the medicine, would be available locally. All seemed fine – yes, insurance would cover the cost, and the pediatrician had us feeling confident that all would be fine. We signed contracts and soon we were in the midst of new teacher orientation at our new school. At this point, teachers were all handed the insurance packets. To our dismay, there was a single sheet inserted into the very same booklet that had been mailed to us many months before. Interestingly enough, this new rider stated that no injectable drugs would be covered under the plan. Coincidence? It seemed a bit shady to us. The headmaster advised us to buy a little bit of the medicine, submit a claim, and set a precedent for the company to pay for it. His thinking was that the smaller dollar amount for just a small amount of the medicine wouldn’t send up any red flags and thus the company would pay for it without question. This also sounded a bit shady. Then came the adventure of trying to access this controlled substance in a foreign country. This was far more difficult than anticipated as the well-loved pediatrician we had been in contact with had died over the summer in a tragic car accident. To make a long story short, our son’s physician back home was a tremendous help and arranged for us to receive the drug directly from the manufacturer at no charge. We were lucky! The only glitch was that it couldn’t be shipped out of the country, so one of us had to fly back to the U.S. to receive it. In future years overseas, the drug company agreed to provide us with a full year’s prescription so that we could take it with us at the beginning of each year. That’s another adventure in this post 9-11 world – carrying a cooler full of ice packs, clear liquid medicine in small glass containers, and a year’s worth of syringes! Fortunately, we knew enough to have a clearly written letter from the physician stating what it was and explaining the need for it.
My advice, like yours, Dr. Spilchuk, would be to be up front about any pertinent medical information despite the potential risks. If a school doesn’t hire you because of it, perhaps it isn’t a school for whom you would wish to work. The school can be your best source of information as to if adequate medical care will be available locally. Once you are overseas, you may very well need the assistance of school officials to access the medical care you require. In a new country, it can be immensely challenging to figure out the system on your own. With regards to the shady dealings of the insurance company with whom we dealt, my advice would be to keep copies of all written communications with representatives of both the school and the insurance company in case you have the misfortune of experiencing anything similar. There might be a possibility of some recourse.
My last piece of advice would be to not let medical challenges keep you from going overseas. Choose your country carefully, do your homework (even though it sometimes backfires), and ask for help when you need it. Having experienced pregnancy, giving birth, childhood diseases, broken bones, and even flask surgery, along with all the miscellaneous health care issues that come along with everyday life, it was all do-able, even without language fluency.
What an amazing response with your first international school with respect to a serious family medical condition! I would venture to say that this was a unique experience, however; it certainly was unlike the situation you described with your second international school. Thank goodness your home physician was able to come through for you and your family!
Jean, I think that your experiences and your advice speak for themselves. They are far more comprehensive and compelling than any responses I might make at this point. Our life stories are a culmination of our lived experiences… and you certainly have lived this problematic experience to the fullest! Thank you so much for sharing with our ISR readers!
Best wishes to you and your family.
Dear Dr. Spilchuk
I am HIV positive but healthy and not on any type of medication. I am on my second overseas assignment, but have to find out secretly, usually, if a country will allow me in without a blood test. I have no plan to get treatment or medication through an insurance company, but just want to know what countries require blood tests for the visas required to work there. The State Dept. web site helps some, but not enough. Is there any good way that you know of to get this information?
I only know intimately about the countries I have come in immediate contact with. For sure, countries in the Gulf region such as Kuwait require testing for HIV. My best advice to you is to go ahead and apply for different positions. When you get a positive response, ask your prospective employer what medical testing is required in that country or by that school. From my experience, I believe you will have to continue to do the “hit and miss” process that you have already been involved in as I do not believe there is a central site for medical requirements for International Schools and/or host countries available to prospective teachers.
Best wishes to you,
Dear Dr. Spilchuk
I did a complete medical check up before I left my last school. Testing included STD & HIV. When I got to Khartoum, however, the Sudanese Govt. required us to take an HIV test. I would have saved a lot of money if I had known this. The blood test was administered at a government hospital which was decidedly suspect with no standards of cleanliness. Blood group testing is also needed for a driving licence, etc. I have friends who some how turned out having different blood group when tested in Sudan; rather scary if you ever have an accident. Luckily I had taken along my own needles and syringes, which I recommend to all international teachers.
Thanks so much for the information you share. I also had to go through an extensive re-medical when I arrived in Kuwait even though I brought my Canadian test results with me. I spent time in Bahrain having blood drawn in circumstances where there is no doubt I would have preferred to use my own needles and syringes. Luckily all turned out well, but your advice in this regard is exceptional! Thank you!