In a recent lecture at the London Academy of Diplomacy,  Dr Franck Scola offered advice on how to stay healthy while on diplomatic business at home and abroad. Barry Tomalin of the London Academy of Diplomacy reports

Dr Franck Scola is a man with a mission: how to keep diplomats and their families sound in body and mind even under the most testing local conditions? As a family doctor based in the south of France with a specialist interest in the medical care of expatriates, he has diagnosed key issues which affect the well-being of diplomats, assignees and their families overseas, and suggests remedies that Human Resources Departments (HR), medical insurers and above all Ministries of Foreign Affairs can put into practice.

The Expat Challenge

Over the past decade the number of expat workers has expanded enormously by 50 per cent. The number of women working abroad has doubled and there has been an increase in the number of families living overseas as a result. Although in Dr Scola’s opinion expat families are less adventurous than they used to be, they have become more demanding, in terms of wanting to know before they depart the local situation regarding administrative matters, such as visas, work permits, accommodation, driving licenses and so on, schooling for children and access to healthcare and insurance coverage. As a result, management, especially HR, has had to take on these increased responsibilities. However, the material issues are not the only thing expats have to deal with – they have to come to terms with the experience of living and working in a different environment – the downside as well as the upside.

Identity Strategy

A French Sociologist at the University of Paris, Philippe Pierre, has identified five attitudes to expatriate living, attitudes which vary in a diplomatic mission, in a family and which change throughout a career. The five groups are Conservatives, Defensives, Converts, Opportunists and Transnationals.

Conservatives manage to live abroad as if they never left home, oblivious to their new postings. Defensives are actively hostile to their new societies and see everything with suspicion. Converts are the opposite: they actively adopt the new society. An example, Dr Scola notes, are Portuguese immigrants in France, many of whom change their children’s names to French names and insist on them learning French at the expense of their Portuguese.  Opportunists are totally focused on their job and don’t really consider their surroundings, and transnationals are at ease anywhere because they are used to travelling and living in different parts of the world – like many diplomats, for example. The point, says Dr Scola, is that you will find each type in an embassy’s staff and that people change over time. His personal interest is how each relates to healthcare in a new country.

In his experience, Conservatives and Defensives are the most resistant to local healthcare because they prefer treatment in their own country and their suspicion of the local healthcare system can amount to a phobia. This often means that they ignore symptoms that could be spotted and treated before developing into serious illness.

Four Key Issues Facing Expatriates

In 15 years of research, observation and analysis, Dr Scola has identified four key issues that affect diplomats and their families overseas. They are specificity, vulnerability, cross-culturality and anticipation.

Specificity. When you are ill abroad you are likely to have questions. Where do you go for treatment? Where do you buy medicine? Is the product the same as at home? How is it dispensed and is the medicine you want on prescription or open sale? This is the problem of specificity. You don’t know how the healthcare system works. You have to find out and it isn’t always easy, especially if the kids are ill and you need help fast.

Vulnerability. When you go and live abroad you face not just physical challenges, but psychological challenges linked to adaptation, as well as social challenges.

Many diplomats consider it taboo to discuss problems of personal adaptation in public. This is a particular problem for partners, especially highly qualified ones, maybe giving up successful careers at home to accompany their partners to a post. Partners and also assignees themselves often feel vulnerable but don’t want to admit it. Interestingly enough, observes Dr Scola, children have less of a problem, their relationships being more horizontal with friends and school than vertical with their parents. Parents with children at post often adapt better than couples without children as they can interact with other parents through the school.

Vulnerability can lead to depression and often, says Dr Scola, the way you spot the first signs of depression is not ‘glum expressions’ but ‘slowing down’ and increased inactivity. Parents who ignore their own problems  can be hypochondriac regarding the slightest cough or sneeze by their children. Dr Scola finds that seeing a child who has absolutely nothing wrong with him or her is actually a very good opportunity to ask the accompanying parent how they are coping, and to open up discussion of their own vulnerability in the new environment.

Networks (even online) are a good way to combat depression and can be helpful in keeping sprits up. However, this can lead to unusual medical solutions. Working with a group of British construction engineers in the south of France, Dr Scola was amused to discover reports of increased access to alternative medicine practitioners (e.g. homeopaths and acupuncturists). Asking why this was he was told  the alternative practitioners had been recommended by friends on their networks!

Cross-culturality. Different communities deal with medical care in different ways. For example, Dr Scola remembers working with French in Brazil. The Brazilians put much more emphasis on preventative healthcare and on sport and diet, so the French colleagues found it difficult to find a public health doctor when they needed one, and had no medical insurance to cover the costs of private healthcare.

Local health givers also need to understand foreign community expectations. Needs may not be recognised by local carers and therefore symptoms may be ignored. This may particularly be a problem with pain relief – in different countries the location of pain and the type of pain may be perceived differently. What is important, says Dr Scola, is to be able to inform the medical practitioner you are consulting with whether the pain you are feeling is acute, sporadic or chronic.

Anticipation. Clearly health problems for diplomats and their families at post are best dealt with by anticipating the problems. This should be done at three levels: pre-departure, on arrival and repatriation.

• Pre-departure: knowledge preparation and information about the language and the country are important, but advice about family issues that might arise is equally crucial.

• Arrival: continued support in the field by an understanding HR manager, along with access to a team of professional local advisers should be available right through the posting.

• Repatriation: both in country and back home, repatriation training (what will have changed), HR support and mentoring by colleagues to re-integrate the home country environment and workplace is vital. Most diplomats will tell you that repatriation is the hardest of all, worse by far than the original re-location.

Forewarned is forearmed. You can’t predict everything, but according to Dr Scola, sympathetic and informed knowledge on the part of healthcare seekers and givers will make everyone in the diplomatic mission happier, more balanced and more productive.