Dealing with Medical, Mental and Eating Disorders

Presenter: Nancy M. Cassel

District 5500, Southern Arizona

When I received the letter asking me to be a panelist on this subject, my first thought was, “What do I know about medical, mental and eating disorders as they relate to an exchange student?”  It didn’t take too long for me to realize I had learned more about it than I ever wanted to know from being a host parent, student counselor and District Youth Exchange Chair. 

Many medical problems were prior conditions that were not disclosed or the extent of the condition was not explained prior to the exchange.

I have found that these problems can be categorized into two main areas: Medical and Cultural.

Medical-Prior Condition: Sponsoring district notified hosting district that student had an accident but that it would not effect the exchange.  The student arrived with several casts and needed extensive medical follow-up.  A doctor examined the student and found healing was not going well and that the student should have further surgery.  Natural parents and sponsoring district were contacted.

Natural parents expected hosting district to cover all medical cost as they were now responsible for the student.  Local doctors did not want to do the surgery due to concerns with the natural parents, extent of injury, etc.  In this case the exchange was terminated due to the medical problem.

Medical-Eating Disorder: YE Chair received call from second host family that they felt there was a problem as the student would not eat and they had heard noises from the bathroom that made them believe the student was purging. When checking with the first host family, Chair was told they had a “confidential conversation” with the student and she had disclosed that she had tried to commit suicide two years prior, but was fine now and wanted to be a model.  Committee members met with the student and problem was discussed.  She denied there was a problem but agreed to be examined by a member of the committee who is a pediatric doctor.  She also agreed to periodic and surprise doctor’s visits to be weighted.  Student weighed quite a bit less than on her application. Medical exam and test showed she was in basic good health but there were some test that showed problems. Student continued with purging, not eating and  weight loss. The exchange was terminated for the concerns over continued student health.

The medical exam by a family doctor who had know her since birth, showed no medical condition or prior conditions.  Did the sponsoring district know of the student’s problems?  Did the screening of the applicant fail?  What was the responsibility of the first host family in reporting the “confidential conversation”?

Medical-Prior Condition: Consider a better situation.  Chair was approached by student and her family with questions relating to a possible exchange.  They wanted to make certain before completing her application that she would be allowed to go on exchange as she had a medical condition.  The girl had Krones disease, had been hospitalized and had also been treated for depression due to side effects from medication. They had contacted her medical doctor and Psychologist  in regards to a possible exchange and requested their opinions. Bother doctors felt she would do well on exchange but would need to have monthly blood test.  Letters were obtained from both doctors with her complete medical records.  When hosting district was approached for an exchange, full disclosure was made prior to sending them the application.  They decided to host the student.  She had a wonderful exchange and was an outstanding student.  She was even asked to be a speaker at the Rotary Youth Exchange Convention in Brisbane but was unable to attend.  Full preparation and disclosure made this exchange work.

Medical-Depression: Student arrived in host country.  Host family very concerned from start.  Student was from a wealthy family but what clothing she had was torn, missing buttons, etc.  Student had no hair brush or other personal items except tooth brush.  Student wanted to wear same clothes for several days at a time.  This was summer in Southern Arizona. Host mother told her this was not acceptable due to body odor and fact that other students would make fun of her.

Host parents were showed pictures of student’s family.  She described them as her smart brother, her beautiful sister and her.  She was a very talented artist and pianist.  Art teacher at school loved her work and asked to display it.  Student said it was no good and destroyed it.  Student was plying host family piano when she slammed the piano closed.  When asked if there was a problem with the piano, as the music was wonderful, the student replied that her mother would not be pleased with her performance.  Excessive sleeping was noted. School contacted host family stating they had talked to student and felt their was an issue with depression.  Student was asked if she wanted to talk to a member of her hosting club that was a psychologist about her feelings.  She agreed.  He reported student was in deep depression and possibly suicidal.  He also felt this was not a new condition and not caused by the exchange.  Student was returned home but I am sorry to say, the sponsoring district sent her right back out on exchange.

Cultural  misunderstandings of a condition or situation can also cause problems.

Cultural: Host family received a letter from the U.S. Customs concerning confiscated medication being sent to their address. It asked if there was a reason for these medication and why they had been sent.  A doctor friend of the family was contacted to see what these medications were and what was there purpose.  First medication was a weight loss drug used for extremely obese patients under a doctor’s care in the hospital.  The second was a skin lightening medication again used under doctor’s supervision.  Student was asked about the medication sent by her mother.  She stated that she could not go home tan and weighing more than was acceptable.  Everyone would think she was poor.  Talked to the student about the problems with these medications and that they were not the answer.  Talked to her about healthy eating, not junk food and soda, and sun protection and creams.  Exchange continued with no further problems in this area.

Cultural: Outbound student after several months in host country doing very well.  She is well liked by hosting club and is doing well with her language skills.  Student received medication by mail from her parent.  Host family became concerned and spoke with club. No medication was indicated on the medical form.  The medication was for attention deficient disorder.  She had been with her mother and brother for her brother’s medical exam shortly before she left.  He has ADD and takes medication.  Student told doctor she sometimes had problems concentrating and so he told her she could try medication to see if it helped her on her exchange.  Sponsoring district was not told of new medication. In the hosting district a person taking this medication is considered suicidal.  Sponsoring district checking with the family and explaining situation to the hosting district.  It had not effect.  Student was given a great going away party and sent home.

In summary these are the concerns I would like to open for discussion:

Prior conditions not disclosed or the extent of condition

Medication not disclosed

Medical exam not “truthful” or “complete”

Screening by both sending and receiving districts

Cultural misunderstanding of conditions

Host family role in reporting possible problem

Discussions with student and parents

Need for open communication

Case handled on individual basis

Finally, I would like you to think about this statement:

We’ve turned the “I can be anything message into the “ I have to be everything-intelligent, athletic, saving the world and of course thin!”