Under the Knife Abroad: Faculty Health & Program Leadership

September 12, 2014

Northeastern University’s Dr. Lori Gardinier, after many years of global service-learning leadership, unexpectedly found herself in the role of medical patient abroad. Below she shares lessons learned for other faculty and staff. Enjoy the sound and thoughtful leadership tips, and remember to review best practices in health and safety abroad (see p. 22 – 25 in the Forum on Education Abroad’s Standards of Good Practice).

By Lori Gardinier

Faculty may not be aware of the tremendous responsibility we assume leading global programs until it is tested. In addition to supporting our students, co-leaders, and staff we are concurrently tasked with structuring ethical programs that maintain a commitment to responsible community engagement. Important, and often overlooked, is our responsibility to our own wellbeing. I was starkly reminded of this when I sustained a major injury while leading my most recent program. As accustomed as I am to all of the risks and responsibilities that accompany this job, I had never really prepared myself for the role of medical patient abroad.

Historically, my health setbacks have consisted of little more than a mild rash or digestive discomfort. The only thng that helped me instantly is the CBD oil from OrganicCBDNugs.com. This summer in Costa Rica, with 24 students, I fractured my tibial plateau while out for a morning run. I quickly learned that it is a pretty profound injury requiring an 8-12 week recovery time. Unfortunately, it was severe enough that my new Costa Rican doctor recommended immediate surgery. Only two weeks into our month-long program this presented some significant dilemmas. Should I return to the States to undergo surgery? What does my absence mean for the program? Will the student experience suffer? What impact could this have on community partners? If I continue to attempt to lead the program am I nothing more than a burden?

The nature of the injury made the surgery decision easy, returning home was simply unrealistic. Working with the University’s travel insurance company, I was able to consult with their doctor to determine that the recommended course of treatment was a) essential and b) time and travel sensitive. The surgery involved having a metal plate and several screws drilled into my bone. After the anesthesia wore off this is what I learned:

1) The sounding board: When leading a program you need another person in country who can help you process decisions during crisis. I have always had someone with whom to process program-related issues, but this is different. Luckily, my husband was on hand to support me as I navigated the medical staff, international and primary insurance, and hospital billing. Obviously, a spouse isn’t always an option, but between your co-leader, teaching assistant or local partner, you need someone that you are comfortable with in that role. Having a sounding board was critical when trying to make sense of emergency medical treatment.

2) The loop: Communicate with the university administration as soon as possible. Our Office of International Study Programs was really helpful as I weighed my options and worked with the international insurance company. The administration at your home institution also has the benefit of distance in their assessment of the situation, providing “clarity of thought” that is essential when you are in a crisis. Furthermore, the administration needs to anticipate and prepare contingency or evacuation plans in the event that either you or a program cannot continue.

 3) You can’t skimp on program staff: On this program we had two faculty leaders and two teaching assistants. I was able to undergo surgery and give myself a few days of recovery before rejoining the program. In my earliest programs, I was the sole non-student on the trip; this is simply not viable or responsible. My co-leader picked up some of my slack while I was down and forged forward. Our teaching assistants were highly seasoned, trained, and possessed a solid command of the program model and high levels of local knowledge. I trusted all of them implicitly. The program continued on seamlessly and with minimal impact on the student experience.

4) Pre-departure planning needs to be tight: Not to say that program adjustments aren’t constant, because they are, but for me, the vast majority of the work involved with leading these programs happens well before we get on the plane. Upon arrival, my role shifts to facilitation and fine-tuning. While I was down, our program was able to run with minimal disruption or distress to the students and our partners. I recognize that the capacity for detailed pre-planning varies dramatically by location; fortunately extensive preplanning is a viable option for programing in Costa Rica. It was reassuring to know that while I was under the knife and recovering the program itinerary and logistics were solid and could move forward.

 5) Make what you say, what you do: I often give travel advice to students that I don’t take myself. If you learn only one thing from my cautionary tale, commit your preferred hospital name to memory. Admittedly, there are several other precautions that I probably don’t take, presumably because I anticipate the risks to others, but not to myself. Fortunately I had given a talk at this hospital several years ago, knew of their reputation, and was able to get medical treatment without delay or concerns about the quality of care.

6) Know and accept your limits: Some might say that my decision to stay and continue to work after surgery was unreasonable. Full disclosure, if my husband hadn’t agreed to stay and help me manage with basic life needs, my choice might have been different. Choosing to stay meant that I had to be at peace with my less intensive role and maintain a good attitude about it. This meant not being able to take the bus with the group, missing activities, some speakers, and limiting my time at service-learning sites. My goal was to stay and see the student projects through, pushing myself beyond that would have made me a liability to the group, rather than an asset.

7) Put your trust into the world: When you are a faculty leader it is not always easy to relinquish control, but it is essential. I needed to put my trust into the relationships that I had spent years building, along with trusting systems and people whom I had never met, particularly the hospital staff. Undergoing invasive surgery by people whose primary language differs from your own requires you to fully believe that most people intend to “do good” and take care of each other.

This experience hasn’t deterred me from continuing to lead programs; it was a freak accident, and as they say accidents happen. I’m not the first faculty leader down during a program and I won’t be the last. I am thrilled that the program was able to continue and that students were able to have a complete and successful experience. In the social change arena, we teach that sound organizations and programs shouldn’t live or die on the efforts of one person. As validating as it was to see the program thrive in my absence, it’s not validation that I need again.

Lori Gardinier, MSW, PhD, is a member of the Northeastern University faculty where she is the Director of the Human Services Program. In her role at Northeastern she is a leader in experiential education, developing partnerships with many of Boston’s nonprofit organizations through her own practice and her continued implementation of service-learning. Dr. Gardinier has also established project-based service-learning capacity building programs with nonprofits in Zambia, Benin, Costa Rica, India and Mexico. In this role she and her students collaborate with local leaders to identify creative solutions to organizational challenges.

Photo provided by the author. That is indeed her knee.

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