This case study is about aid workers/missionaries who take their family on a longer term assignment.

Sam was an aid worker married to Gill. Both of them had done a number of missions with both secular and faith based organisations but decided they would settle down for a few years back home before thinking of any more trips overseas. Home was in fact Nairobi as Sam was Kenyan, though Gill was Scottish.

Just after their third child was born an offer of a four year posting to South east Asia came up and after a lot of prayerful reflection they decided to go for it. They would be based in Phnom Penh. Gill would do some regional travel as a micro credit adviser and Sam would be largely based at home but as a nurse would have a part-time job in the international school. Their children were 4, 2 and 6 months of age, all well, except the middle one, Precious, who had recurrent attacks of mild asthma.

The mission was due to start in 6 months. Although most of their time would be in Cambodia, Gill’s job would take her to at least 6 countries on short visits. They had earmarked two favourite resorts, one in Thailand and one in India for a possible family holiday.

Sam’s big concern was taking a family to live overseas. He was keen to have as much information as possible about the wider health and welfare issues for their children, not least to reassure his extended family in Kenya. He was keen to know how to minimize any risk to the children’s health when abroad. Two friends had lost children in DRCongo, one from a road crash and the other from a domestic accident.

Meanwhile Gill was keen to find out about the various immunisations she night need for all the countries she was visiting.

Would she need boosters?

What about vaccinations against cholera and Japanese Encephalitis?

She also realized that there were other health hazards, including avian flu and a new disease people were talking about, Chikungunya fever. And then, of course, there was malaria. It was easy when she was an aid worker in Sierre Leone as it was antimalarials all the time, but far more complex in 6 countries with varying risks, depending on time of year and type of travel.

One big problem Gill faced was hostility from her wider family who thought a jump from Nairobi to South East Asia was one too many, especially with all the unknown health risks.

Their organisation told them they could find answers to many of their questions on the THAC website. Their HQ staff and desk officers always consulted this a few weeks before any overseas trip and found it most useful.

There was a lot to look up. They were able to find an updated fact sheet on avian flu, and enough information on immunisations so they could work out a schedule for the whole family, as minimum ages and specific recommendations were included for children. Detailed malaria information on each country put their mind at risk. They found a fact sheet on asthma which they used as a basis for discussion when they visited their family doctor. There was even a fact sheet on “Chic fever”, updated within the last month. There was a detailed fact sheet on taking children abroad and how to carry out a “risk assessment” of the home and its immediate surroundings. Also how to minimize the risk of road crashes.

Sam had been a keen environmentalist and scuba diver when a student in East Africa, but was keen to have a reminder on the latest information on snake and scorpion bites and diving hazards, as he was secretly hoping for occasional “rewards” for being the primary child minder. Being responsible for the health and welfare of the international school he was also interested in being able to find answers to the common health questions he was likely to be asked.

The mission generally went well, the children remained in good health but Gill became increasingly exhausted and felt her work-life was suffering. She needed some advice as a self-help tool. Before talking to a close friend during her next trip to Bangkok she wondered if THAC might have some tips on this. To her relief there was a whole section which she used with success over the coming months, both to monitor her sense of well being and to take practical steps to help put the situation right.

The time was coming to return home to Nairobi, via a stay in Glasgow. The mission had lasted a full four years with brief annual trips to their respective home countries, and they realized they would find settling back into Nairobi challenging. They were also a bit worried about their children after hearing some expats talking about “Third Culture Kids” a term they were unfamiliar with.

Would THAC be able to help?
Using the search facility they put in the words reverse culture shock and TCKs and found a wealth of information which helped to answer their very questions. It also pointed them to useful books and articles to read. Also that they could pre-book a phone consultation with a counsellor at InterHealth who understood these issues...

One of the most rewarding parts of their time in South East Asia was a visit from Gill’s parents, originally so hostile to the idea of them and the grandchildren so far afield. Gill had boldly suggested that they should plan to come out for a 2 week holiday. Gill’s advice to her parents had been “Think about the health concerns you have both for us and for yourselves, then go into THAC and press the right icons or carry out a search. Then if you are still worried after studying the information and reading a copy of the recommended health manual, let’s talk on Skype... Even Grandpa’s concern about flying with controlled angina and how to cope with his diabetes was covered on the fact sheets he downloaded.