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Blogs | Health Tips

Managing a long-term condition

Having a chronic condition shouldn’t stand in your way of pursuing a life overseas. But what research should you do before you leave and what questions need to be asked?

With an estimated five million Britons now living or working abroad, it’s becoming increasingly likely that people will need to explore their options for long-term therapy at some point.

Used to describe a range of conditions that can be classified as ‘chronic’ –such as diabetes, high blood pressure, renal failure, depression or back pain, long-term therapy represents any ongoing treatments that naturally fall outside your health insurance plan.

While comprehensive policies offer varying levels of cover that encompass a certain number of sessions, period of time or cost for specific conditions, insurance is essentially designed for curative treatment – offering immediate support in the event of an acute illness or accident.

Surgery

Can I still more overseas?

That doesn’t mean that having a chronic condition should preclude any ambition to live abroad – far from it. However, the awareness of any issue will call for some detailed research in advance to ensure that there is an adequate support structure ready and waiting.

Likewise, it doesn’t automatically follow that developing a chronic condition will necessitate an early return – with excellent local facilities, treatments and available medication often available at reasonable prices.

What questions should I ask?

In the first instance, any pre-existing conditions should be discussed in-depth with a GP. The next step is to understand exactly what’s available to you once you make the move.

If you are travelling with a pre-existing condition or would just like to build an accurate picture of health facilities in your chosen destination, key questions to ask include:

  • Is your chronic condition routinely catered for?
  • Does any one facility specialise in your condition?
  • If so, what are the facilities like?
  • How do the standards of care differ between facilities?
  • Is it possible to get good standards of care at a reasonable cost?
  • Is your prescribed medication available in this country?
  • If so, what will your annual costs be for treatment/medication?
  • How will these costs compare if you source your prescription via a hospital pharmacy or private doctor?
  • How do these payments work?
  • Are they part- or fully-funded by any state contributions you make – and if so, when would you become eligible?
  • How do waiting times vary if you pursue state-funded treatment?
  • Where do the locals/expats typically go for treatments? (for example, it’s common for Hong Kong residents to visit Thailand for therapies)
  • What advice/support is your employer willing to offer?
  • If required, what support structure would be available for your family?

 

Having a good grasp of cultural/religious differences is also vital to ensuring you get the care you want in your adopted country. For example, mental illness is rarely talked about in the Far East, so finding a clinic that specialises in depression could prove difficult.

Hospital

Seek local advice

Expats and locals are a rich source of information, offering newcomers crucial recommendations and reviews. Additional web searches will help you poll further opinions and focus on your own condition.

Be sure to ask:

  • For other expats’ experiences of local healthcare facilities and doctors
  • What pitfalls you need to be aware of – for example, the best way to cut down on waiting times/or access the best care

Expert view

Dr Jace Clarke, Chief Medical Officer with William Russell

“Continuing advances in medicine mean that there’s a lot more doctors can do these days for people with chronic conditions. This effectively means that people heading abroad have far more options when it comes to where they choose to live. Expat hubs such as Dubai, Bangkok and Hong Kong all offer excellent facilities and expertise at reasonable cost, so for patients looking for long-term therapies, sourcing the right care will come down to researching your own needs and finding the best evidence-based treatment.”

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Blogs | Expat Stories

How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Blogs | Health Tips

Can you have a healthy Chinese new year?

How do the Chinese celebrate the Lunar New Year, and is the event physically or mentally beneficial?

Often considered the most important day of the year in China, the Lunar New Year requires much preparation.

In terms of your health, the mental benefits are certainly more obvious than the physical, but here are some examples of how you can embrace the event in a way that helps both.

Chinese New Year

Start as you mean to go on

The holiday period is seen as the traditional time to settle any grievances with family. This could include any arguments, long-standing grudges, or even financial matters in an attempt to begin the New Year with a clean slate.

The same goes for your home; the days before the New Year is the time to sweep your home, and clear away your worries. However, using your broom in the first few days after the New Year is said to wipe out any good luck.

This is just one of a wide range of traditions that are seen as lucky over the holiday season. Homes are decorated with red and gold banners, while red envelopes filled with money are presented to children and the elderly, as well as to single adults.

As the colour red is considered to be lucky, wrapping money in red envelopes is expected to bestow more happiness and blessings on the receivers.

TIP: Given the significance of the red envelope, it is considered a faux-pas to open it in front of the person who gives it to you.

Colorful Chinese knot decorations
Chinese knot can be used in the occasions of Chinese New Year, Holiday wedding, Celebration to express good token for love, luck, happy, unite, friendship, reunion, and prosperities.

Can you stay healthy?

This year is the year of the rooster, and people born in this zodiac year are considered to have many positive traits, such as being honest, bright, communicative and ambitious.

It is also a year associated with being healthy, sporty and self-assured.

With food carrying such a vital role in Chinese New Year celebrations, you could enjoy a healthy feast. Fruit is considered to be one of the 7 ‘lucky’ foods, associated with fullness and wealth, while fish symbolises an increase in prosperity.

However, be careful how you eat the fish. The head should be placed in the direction of distinguished or older guests, as a mark of respect – and these guests should eat first.

Happy Chinese New Year!

Blogs | Health Tips

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Blogs | Insurance Insights

What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Blogs | Insurance Insights

Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

Find out more >parent_and_child_at_beach

Blogs | Insurance Insights

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Blogs | Health Alert

Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

Blogs | Health Alert

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Blogs | Health Tips

Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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Maternity care and benefits in Hong Kong

What can expats in Hong Kong expect from maternity care and parental benefits?

If you are employed in the UK and become pregnant, you and your spouse can take almost a year off – and its even more in Sweden. Maternity can also vary from country to country.

However, in Hong Kong, parental rights still lag behind other countries, with just 10 weeks leave for new mothers and a mere three days for fathers, at four-fifths of salary.

Despite flagship employer HSBC last year improving its maternity leave from 12 to 14 weeks, and doubling paternity leave to two weeks, to bring it into line with international standards, there is no sign that Hong Kong’s Labour Department will follow that lead.

It says the current deal strikes “a reasonable balance between the interests of employers and employees”.

In terms of health care, the government health system provides comprehensive maternity care for a limited cost, providing patients are pre-registered. Private maternity care provides the additional benefit of continuity of care and greater involvement for both parents.

Tackling old mindsets

The Women’s Foundation in Hong Kong says women still face traditional mindsets in the home and in the workplace, and one issue facing big multinational employers is “finding the right balance between global policies and local cultural considerations”.

Su-Mei Thompson, the foundation’s CEO says: “One of the major contributors to the problem is Hong Kong’s Employment Ordinance, which provides for just 10 weeks of statutory maternity leave – well behind the 14-week minimum proposed by the International Labour Organization (ILO), based on considerations of maternal health and infant wellbeing.

“China is at 14 weeks and Singapore is at 16 weeks, so we think it is time Hong Kong stepped up to the plate. Hong Kong also provides for only three days of statutory paternity leave.”

She continues: “What’s interesting is that many countries and companies (like Facebook, Netflix and Microsoft) have ditched the traditional concept of maternity and paternity leave in favour of gender neutral parental leave which gives parents the choice which one of them will take the time off to care for the baby.”

As many as 61 countries allow at least 14 weeks leave on full pay, according to the ILO, the average in Asia is 12.7 weeks, while the UK (50 weeks), Australia (52) and Sweden (68) are among countries that permit parents to share the allowance and thus the duties. Funding varies, with full pay typically available only for part of the leave.

woman working with a baby

Maternity benefits in Hong Kong: What am I entitled to?

Certain conditions, such as length of employment and contract status, must be met to receive statutory maternity benefits, with maternity pay amounting to four-fifths of your average daily pay for the 12 months prior to going on leave.

If you and your employer agree, you can wait until up to two weeks before your expected due date to go on leave. Otherwise, you should start four weeks before that date. You can’t be dismissed between giving your employer notice and when you return from leave, except for serious misconduct or if you are on probation.

Maternity care in Hong Kong: What to expect

Government-funded health care includes pregnancy check-ups, tests and ultrasounds, labour, birth care and aftercare. A doctor will only deliver the baby if the case is high risk, and you may not know the doctor or midwife attending you.

In the private health system, the same doctor will care for you throughout pregnancy and in a hospital of your choice. The father is also allowed to join the mother throughout the whole process, not just in the birthing room.

Midwife and commentator Hulda Thorey says: “The government system is capable of giving excellent care for low cost and good safety. The major complaints have mostly to do with inefficient use of time, lack of communication skills and flexibility.

“Generally speaking, if you have insurance for a private hospital birth, fully covering any care, it is well worth finding a doctor and hospital that suits you. You just need to identify in advance what exactly you are looking for, and what is actually available in each one of them.”

International maternity insurance plans will normally allow you to choose your own doctor or hospital, but in busy Hong Kong you may need to decide and book as soon as pregnancy begins.

Insurers will impose a minimum 10-month waiting period for cover to begin, so the health insurance policy must be in place before you are pregnant. Basic policies may only include cover for complications in pregnancy, with fuller policies covering routine maternity care and childbirth, emergency surgical procedures, as well as cover for newborns, with varying levels of protection.

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Expat life: managing stress in Hong Kong

Becoming an expat in Hong Kong is an exciting prospect, but living in the city can bring mental challenges and worries for expats. How can you manage the potential stress of making a move?

Living and working in Hong Kong can lead to stresses associated with the lifestyle and environment of the city. For example, global research by Swiss banking group UBS has found that Hong Kong residents clocked up the longest working hours anywhere – at 50.1 per week, accompanied by just 17 days of annual leave.

As well as the stresses of working life, there can also be a whole set of domestic challenges in adapting to what will be a very different culture for many people – potentially affecting all family members.

WR-combined-image-with-caption-900x560-2

“When you consider that starting a new job and moving house are known to constitute some of life’s greatest stresses, it’s easy to see why being an expat can sometimes be so difficult,” explains Karin Sieger, a London-based psychotherapist who works with expats.

“They are literally having to undergo what would normally be individual experiences all at once. And that’s not counting the impact that taking your children abroad may have – or even choosing to give birth in a foreign country.”

Having previously worked in Hong Kong herself, Sieger, who is accredited and registered with the British Association for Counselling and Psychotherapy, now runs dedicated workshops for expats on the emotional challenges of either coming from or moving to other countries.

Seattle-based therapist Anita Colombara, who spent four years working in Cambodia with an NGO, adds: “Sometimes these challenges can negatively impact an expat’s emotional wellbeing and their relationships with family and friends – or lead them to develop unhealthy behaviours to cope with it all.”

Understanding the issues to manage stress

While people who may have had problems in the past should think about their wellbeing, Sieger recommends that people who do not usually consider their mental health should also contemplate the probable stress once they make the move.

“People can burn out a lot quicker when they’re living abroad, and expats need to realise that they might not be able to access the same level of support that they could expect at home – even if they’re working for the same employer.”

Colombara, who faced her own mental health challenges when working in Cambodia, realised she was not alone, and set up Remote Access Mental Health on her return to the US – which allows expats to undertake therapy via video conferencing, wherever they happen to be.

Hong Kong urban scene

Finding support

Having a support network in place is an integral part of maintaining good mental health, according to Sieger, who underlines that the transient nature of expat life means that it’s essential to keep in touch with a good base of people back home.

“It’s not uncommon for people to want to put a brave face on, in front of what is usually a limited community,” she says, “often for fear of being gossiped about or things getting back to their employer. That makes it all the more important that they maintain some sort of outlet.”

Colombara adds that seeking therapy in such a tight enclave can be awkward.

“Even if there is a professional therapist available, it is very likely they are already acquainted,” she points out, “making professional boundaries difficult to establish. The intimacy of an expat community can also make privacy challenging. However, I would say that the biggest barrier to getting therapy is really the denial that there are issues that need to be addressed.”

Tips for managing stress

Siegel recommends several self-help measures for any expat’s mental wellbeing, while online resources can also help:

  • Preserving continuity: If there’s something you enjoy doing – a sport, or certain hobby, for example – then keep doing it!
  • Establishing a daily routine: Having something that is known and familiar makes us feel good.
  • Learning something new: Try to find a fun activity or pastime that has a direct link to the country you’re in. It will help you feel a connection to the place you’re in and to bring something new to your life.
  • Setting some ground rules: Time differences can make it easy to fall into working out of hours. Don’t be tempted just to try and fit in – establish some firm time boundaries, stick to them and keep some quality ‘me’ or family’ time.
  • Consider using online counselling, and joining expat forums for tips, advice and contacts for potential support networks.

Available treatments

If you would like to seek guidance about any mental health issue, Sieger’s advice is to find a therapist who will look at what you want to achieve and outline the processes that you use.

As a rule of thumb, counselling tends to be short- to medium-term, whereas psychotherapy is used for people over a longer time frame.

“In large, cosmopolitan cities such as Hong Kong, mental health services are not normally difficult to access as long as people take the initiative to seek them out,” Colombara says. “My suggestion is to ask an international hospital or primary care doctor for mental health resources. There are also some well-resourced international churches or expat forums that could probably provide some good referrals.”

Expats should also check whether their health insurance policy includes cover for mental health services, to help with access to any professional services and treatments.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

Ipad Video Conf

Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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Managing a long-term condition

Having a chronic condition shouldn’t stand in your way of pursuing a life overseas. But what research should you do before you leave and what questions need to be asked?

With an estimated five million Britons now living or working abroad, it’s becoming increasingly likely that people will need to explore their options for long-term therapy at some point.

Used to describe a range of conditions that can be classified as ‘chronic’ –such as diabetes, high blood pressure, renal failure, depression or back pain, long-term therapy represents any ongoing treatments that naturally fall outside your health insurance plan.

While comprehensive policies offer varying levels of cover that encompass a certain number of sessions, period of time or cost for specific conditions, insurance is essentially designed for curative treatment – offering immediate support in the event of an acute illness or accident.

Surgery

Can I still more overseas?

That doesn’t mean that having a chronic condition should preclude any ambition to live abroad – far from it. However, the awareness of any issue will call for some detailed research in advance to ensure that there is an adequate support structure ready and waiting.

Likewise, it doesn’t automatically follow that developing a chronic condition will necessitate an early return – with excellent local facilities, treatments and available medication often available at reasonable prices.

What questions should I ask?

In the first instance, any pre-existing conditions should be discussed in-depth with a GP. The next step is to understand exactly what’s available to you once you make the move.

If you are travelling with a pre-existing condition or would just like to build an accurate picture of health facilities in your chosen destination, key questions to ask include:

  • Is your chronic condition routinely catered for?
  • Does any one facility specialise in your condition?
  • If so, what are the facilities like?
  • How do the standards of care differ between facilities?
  • Is it possible to get good standards of care at a reasonable cost?
  • Is your prescribed medication available in this country?
  • If so, what will your annual costs be for treatment/medication?
  • How will these costs compare if you source your prescription via a hospital pharmacy or private doctor?
  • How do these payments work?
  • Are they part- or fully-funded by any state contributions you make – and if so, when would you become eligible?
  • How do waiting times vary if you pursue state-funded treatment?
  • Where do the locals/expats typically go for treatments? (for example, it’s common for Hong Kong residents to visit Thailand for therapies)
  • What advice/support is your employer willing to offer?
  • If required, what support structure would be available for your family?

 

Having a good grasp of cultural/religious differences is also vital to ensuring you get the care you want in your adopted country. For example, mental illness is rarely talked about in the Far East, so finding a clinic that specialises in depression could prove difficult.

Hospital

Seek local advice

Expats and locals are a rich source of information, offering newcomers crucial recommendations and reviews. Additional web searches will help you poll further opinions and focus on your own condition.

Be sure to ask:

  • For other expats’ experiences of local healthcare facilities and doctors
  • What pitfalls you need to be aware of – for example, the best way to cut down on waiting times/or access the best care

Expert view

Dr Jace Clarke, Chief Medical Officer with William Russell

“Continuing advances in medicine mean that there’s a lot more doctors can do these days for people with chronic conditions. This effectively means that people heading abroad have far more options when it comes to where they choose to live. Expat hubs such as Dubai, Bangkok and Hong Kong all offer excellent facilities and expertise at reasonable cost, so for patients looking for long-term therapies, sourcing the right care will come down to researching your own needs and finding the best evidence-based treatment.”

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How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Can you have a healthy Chinese new year?

How do the Chinese celebrate the Lunar New Year, and is the event physically or mentally beneficial?

Often considered the most important day of the year in China, the Lunar New Year requires much preparation.

In terms of your health, the mental benefits are certainly more obvious than the physical, but here are some examples of how you can embrace the event in a way that helps both.

Chinese New Year

Start as you mean to go on

The holiday period is seen as the traditional time to settle any grievances with family. This could include any arguments, long-standing grudges, or even financial matters in an attempt to begin the New Year with a clean slate.

The same goes for your home; the days before the New Year is the time to sweep your home, and clear away your worries. However, using your broom in the first few days after the New Year is said to wipe out any good luck.

This is just one of a wide range of traditions that are seen as lucky over the holiday season. Homes are decorated with red and gold banners, while red envelopes filled with money are presented to children and the elderly, as well as to single adults.

As the colour red is considered to be lucky, wrapping money in red envelopes is expected to bestow more happiness and blessings on the receivers.

TIP: Given the significance of the red envelope, it is considered a faux-pas to open it in front of the person who gives it to you.

Colorful Chinese knot decorations
Chinese knot can be used in the occasions of Chinese New Year, Holiday wedding, Celebration to express good token for love, luck, happy, unite, friendship, reunion, and prosperities.

Can you stay healthy?

This year is the year of the rooster, and people born in this zodiac year are considered to have many positive traits, such as being honest, bright, communicative and ambitious.

It is also a year associated with being healthy, sporty and self-assured.

With food carrying such a vital role in Chinese New Year celebrations, you could enjoy a healthy feast. Fruit is considered to be one of the 7 ‘lucky’ foods, associated with fullness and wealth, while fish symbolises an increase in prosperity.

However, be careful how you eat the fish. The head should be placed in the direction of distinguished or older guests, as a mark of respect – and these guests should eat first.

Happy Chinese New Year!

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What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

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Blogs | Health Alert

Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

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Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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Blogs | Hong Kong City Guide

Maternity care and benefits in Hong Kong

What can expats in Hong Kong expect from maternity care and parental benefits?

If you are employed in the UK and become pregnant, you and your spouse can take almost a year off – and its even more in Sweden. Maternity can also vary from country to country.

However, in Hong Kong, parental rights still lag behind other countries, with just 10 weeks leave for new mothers and a mere three days for fathers, at four-fifths of salary.

Despite flagship employer HSBC last year improving its maternity leave from 12 to 14 weeks, and doubling paternity leave to two weeks, to bring it into line with international standards, there is no sign that Hong Kong’s Labour Department will follow that lead.

It says the current deal strikes “a reasonable balance between the interests of employers and employees”.

In terms of health care, the government health system provides comprehensive maternity care for a limited cost, providing patients are pre-registered. Private maternity care provides the additional benefit of continuity of care and greater involvement for both parents.

Tackling old mindsets

The Women’s Foundation in Hong Kong says women still face traditional mindsets in the home and in the workplace, and one issue facing big multinational employers is “finding the right balance between global policies and local cultural considerations”.

Su-Mei Thompson, the foundation’s CEO says: “One of the major contributors to the problem is Hong Kong’s Employment Ordinance, which provides for just 10 weeks of statutory maternity leave – well behind the 14-week minimum proposed by the International Labour Organization (ILO), based on considerations of maternal health and infant wellbeing.

“China is at 14 weeks and Singapore is at 16 weeks, so we think it is time Hong Kong stepped up to the plate. Hong Kong also provides for only three days of statutory paternity leave.”

She continues: “What’s interesting is that many countries and companies (like Facebook, Netflix and Microsoft) have ditched the traditional concept of maternity and paternity leave in favour of gender neutral parental leave which gives parents the choice which one of them will take the time off to care for the baby.”

As many as 61 countries allow at least 14 weeks leave on full pay, according to the ILO, the average in Asia is 12.7 weeks, while the UK (50 weeks), Australia (52) and Sweden (68) are among countries that permit parents to share the allowance and thus the duties. Funding varies, with full pay typically available only for part of the leave.

woman working with a baby

Maternity benefits in Hong Kong: What am I entitled to?

Certain conditions, such as length of employment and contract status, must be met to receive statutory maternity benefits, with maternity pay amounting to four-fifths of your average daily pay for the 12 months prior to going on leave.

If you and your employer agree, you can wait until up to two weeks before your expected due date to go on leave. Otherwise, you should start four weeks before that date. You can’t be dismissed between giving your employer notice and when you return from leave, except for serious misconduct or if you are on probation.

Maternity care in Hong Kong: What to expect

Government-funded health care includes pregnancy check-ups, tests and ultrasounds, labour, birth care and aftercare. A doctor will only deliver the baby if the case is high risk, and you may not know the doctor or midwife attending you.

In the private health system, the same doctor will care for you throughout pregnancy and in a hospital of your choice. The father is also allowed to join the mother throughout the whole process, not just in the birthing room.

Midwife and commentator Hulda Thorey says: “The government system is capable of giving excellent care for low cost and good safety. The major complaints have mostly to do with inefficient use of time, lack of communication skills and flexibility.

“Generally speaking, if you have insurance for a private hospital birth, fully covering any care, it is well worth finding a doctor and hospital that suits you. You just need to identify in advance what exactly you are looking for, and what is actually available in each one of them.”

International maternity insurance plans will normally allow you to choose your own doctor or hospital, but in busy Hong Kong you may need to decide and book as soon as pregnancy begins.

Insurers will impose a minimum 10-month waiting period for cover to begin, so the health insurance policy must be in place before you are pregnant. Basic policies may only include cover for complications in pregnancy, with fuller policies covering routine maternity care and childbirth, emergency surgical procedures, as well as cover for newborns, with varying levels of protection.

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Expat life: managing stress in Hong Kong

Becoming an expat in Hong Kong is an exciting prospect, but living in the city can bring mental challenges and worries for expats. How can you manage the potential stress of making a move?

Living and working in Hong Kong can lead to stresses associated with the lifestyle and environment of the city. For example, global research by Swiss banking group UBS has found that Hong Kong residents clocked up the longest working hours anywhere – at 50.1 per week, accompanied by just 17 days of annual leave.

As well as the stresses of working life, there can also be a whole set of domestic challenges in adapting to what will be a very different culture for many people – potentially affecting all family members.

WR-combined-image-with-caption-900x560-2

“When you consider that starting a new job and moving house are known to constitute some of life’s greatest stresses, it’s easy to see why being an expat can sometimes be so difficult,” explains Karin Sieger, a London-based psychotherapist who works with expats.

“They are literally having to undergo what would normally be individual experiences all at once. And that’s not counting the impact that taking your children abroad may have – or even choosing to give birth in a foreign country.”

Having previously worked in Hong Kong herself, Sieger, who is accredited and registered with the British Association for Counselling and Psychotherapy, now runs dedicated workshops for expats on the emotional challenges of either coming from or moving to other countries.

Seattle-based therapist Anita Colombara, who spent four years working in Cambodia with an NGO, adds: “Sometimes these challenges can negatively impact an expat’s emotional wellbeing and their relationships with family and friends – or lead them to develop unhealthy behaviours to cope with it all.”

Understanding the issues to manage stress

While people who may have had problems in the past should think about their wellbeing, Sieger recommends that people who do not usually consider their mental health should also contemplate the probable stress once they make the move.

“People can burn out a lot quicker when they’re living abroad, and expats need to realise that they might not be able to access the same level of support that they could expect at home – even if they’re working for the same employer.”

Colombara, who faced her own mental health challenges when working in Cambodia, realised she was not alone, and set up Remote Access Mental Health on her return to the US – which allows expats to undertake therapy via video conferencing, wherever they happen to be.

Hong Kong urban scene

Finding support

Having a support network in place is an integral part of maintaining good mental health, according to Sieger, who underlines that the transient nature of expat life means that it’s essential to keep in touch with a good base of people back home.

“It’s not uncommon for people to want to put a brave face on, in front of what is usually a limited community,” she says, “often for fear of being gossiped about or things getting back to their employer. That makes it all the more important that they maintain some sort of outlet.”

Colombara adds that seeking therapy in such a tight enclave can be awkward.

“Even if there is a professional therapist available, it is very likely they are already acquainted,” she points out, “making professional boundaries difficult to establish. The intimacy of an expat community can also make privacy challenging. However, I would say that the biggest barrier to getting therapy is really the denial that there are issues that need to be addressed.”

Tips for managing stress

Siegel recommends several self-help measures for any expat’s mental wellbeing, while online resources can also help:

  • Preserving continuity: If there’s something you enjoy doing – a sport, or certain hobby, for example – then keep doing it!
  • Establishing a daily routine: Having something that is known and familiar makes us feel good.
  • Learning something new: Try to find a fun activity or pastime that has a direct link to the country you’re in. It will help you feel a connection to the place you’re in and to bring something new to your life.
  • Setting some ground rules: Time differences can make it easy to fall into working out of hours. Don’t be tempted just to try and fit in – establish some firm time boundaries, stick to them and keep some quality ‘me’ or family’ time.
  • Consider using online counselling, and joining expat forums for tips, advice and contacts for potential support networks.

Available treatments

If you would like to seek guidance about any mental health issue, Sieger’s advice is to find a therapist who will look at what you want to achieve and outline the processes that you use.

As a rule of thumb, counselling tends to be short- to medium-term, whereas psychotherapy is used for people over a longer time frame.

“In large, cosmopolitan cities such as Hong Kong, mental health services are not normally difficult to access as long as people take the initiative to seek them out,” Colombara says. “My suggestion is to ask an international hospital or primary care doctor for mental health resources. There are also some well-resourced international churches or expat forums that could probably provide some good referrals.”

Expats should also check whether their health insurance policy includes cover for mental health services, to help with access to any professional services and treatments.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

Ipad Video Conf

Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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Managing a long-term condition

Having a chronic condition shouldn’t stand in your way of pursuing a life overseas. But what research should you do before you leave and what questions need to be asked?

With an estimated five million Britons now living or working abroad, it’s becoming increasingly likely that people will need to explore their options for long-term therapy at some point.

Used to describe a range of conditions that can be classified as ‘chronic’ –such as diabetes, high blood pressure, renal failure, depression or back pain, long-term therapy represents any ongoing treatments that naturally fall outside your health insurance plan.

While comprehensive policies offer varying levels of cover that encompass a certain number of sessions, period of time or cost for specific conditions, insurance is essentially designed for curative treatment – offering immediate support in the event of an acute illness or accident.

Surgery

Can I still more overseas?

That doesn’t mean that having a chronic condition should preclude any ambition to live abroad – far from it. However, the awareness of any issue will call for some detailed research in advance to ensure that there is an adequate support structure ready and waiting.

Likewise, it doesn’t automatically follow that developing a chronic condition will necessitate an early return – with excellent local facilities, treatments and available medication often available at reasonable prices.

What questions should I ask?

In the first instance, any pre-existing conditions should be discussed in-depth with a GP. The next step is to understand exactly what’s available to you once you make the move.

If you are travelling with a pre-existing condition or would just like to build an accurate picture of health facilities in your chosen destination, key questions to ask include:

  • Is your chronic condition routinely catered for?
  • Does any one facility specialise in your condition?
  • If so, what are the facilities like?
  • How do the standards of care differ between facilities?
  • Is it possible to get good standards of care at a reasonable cost?
  • Is your prescribed medication available in this country?
  • If so, what will your annual costs be for treatment/medication?
  • How will these costs compare if you source your prescription via a hospital pharmacy or private doctor?
  • How do these payments work?
  • Are they part- or fully-funded by any state contributions you make – and if so, when would you become eligible?
  • How do waiting times vary if you pursue state-funded treatment?
  • Where do the locals/expats typically go for treatments? (for example, it’s common for Hong Kong residents to visit Thailand for therapies)
  • What advice/support is your employer willing to offer?
  • If required, what support structure would be available for your family?

 

Having a good grasp of cultural/religious differences is also vital to ensuring you get the care you want in your adopted country. For example, mental illness is rarely talked about in the Far East, so finding a clinic that specialises in depression could prove difficult.

Hospital

Seek local advice

Expats and locals are a rich source of information, offering newcomers crucial recommendations and reviews. Additional web searches will help you poll further opinions and focus on your own condition.

Be sure to ask:

  • For other expats’ experiences of local healthcare facilities and doctors
  • What pitfalls you need to be aware of – for example, the best way to cut down on waiting times/or access the best care

Expert view

Dr Jace Clarke, Chief Medical Officer with William Russell

“Continuing advances in medicine mean that there’s a lot more doctors can do these days for people with chronic conditions. This effectively means that people heading abroad have far more options when it comes to where they choose to live. Expat hubs such as Dubai, Bangkok and Hong Kong all offer excellent facilities and expertise at reasonable cost, so for patients looking for long-term therapies, sourcing the right care will come down to researching your own needs and finding the best evidence-based treatment.”

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How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Can you have a healthy Chinese new year?

How do the Chinese celebrate the Lunar New Year, and is the event physically or mentally beneficial?

Often considered the most important day of the year in China, the Lunar New Year requires much preparation.

In terms of your health, the mental benefits are certainly more obvious than the physical, but here are some examples of how you can embrace the event in a way that helps both.

Chinese New Year

Start as you mean to go on

The holiday period is seen as the traditional time to settle any grievances with family. This could include any arguments, long-standing grudges, or even financial matters in an attempt to begin the New Year with a clean slate.

The same goes for your home; the days before the New Year is the time to sweep your home, and clear away your worries. However, using your broom in the first few days after the New Year is said to wipe out any good luck.

This is just one of a wide range of traditions that are seen as lucky over the holiday season. Homes are decorated with red and gold banners, while red envelopes filled with money are presented to children and the elderly, as well as to single adults.

As the colour red is considered to be lucky, wrapping money in red envelopes is expected to bestow more happiness and blessings on the receivers.

TIP: Given the significance of the red envelope, it is considered a faux-pas to open it in front of the person who gives it to you.

Colorful Chinese knot decorations
Chinese knot can be used in the occasions of Chinese New Year, Holiday wedding, Celebration to express good token for love, luck, happy, unite, friendship, reunion, and prosperities.

Can you stay healthy?

This year is the year of the rooster, and people born in this zodiac year are considered to have many positive traits, such as being honest, bright, communicative and ambitious.

It is also a year associated with being healthy, sporty and self-assured.

With food carrying such a vital role in Chinese New Year celebrations, you could enjoy a healthy feast. Fruit is considered to be one of the 7 ‘lucky’ foods, associated with fullness and wealth, while fish symbolises an increase in prosperity.

However, be careful how you eat the fish. The head should be placed in the direction of distinguished or older guests, as a mark of respect – and these guests should eat first.

Happy Chinese New Year!

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What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

Find out more >parent_and_child_at_beach

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Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

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Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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Maternity care and benefits in Hong Kong

What can expats in Hong Kong expect from maternity care and parental benefits?

If you are employed in the UK and become pregnant, you and your spouse can take almost a year off – and its even more in Sweden. Maternity can also vary from country to country.

However, in Hong Kong, parental rights still lag behind other countries, with just 10 weeks leave for new mothers and a mere three days for fathers, at four-fifths of salary.

Despite flagship employer HSBC last year improving its maternity leave from 12 to 14 weeks, and doubling paternity leave to two weeks, to bring it into line with international standards, there is no sign that Hong Kong’s Labour Department will follow that lead.

It says the current deal strikes “a reasonable balance between the interests of employers and employees”.

In terms of health care, the government health system provides comprehensive maternity care for a limited cost, providing patients are pre-registered. Private maternity care provides the additional benefit of continuity of care and greater involvement for both parents.

Tackling old mindsets

The Women’s Foundation in Hong Kong says women still face traditional mindsets in the home and in the workplace, and one issue facing big multinational employers is “finding the right balance between global policies and local cultural considerations”.

Su-Mei Thompson, the foundation’s CEO says: “One of the major contributors to the problem is Hong Kong’s Employment Ordinance, which provides for just 10 weeks of statutory maternity leave – well behind the 14-week minimum proposed by the International Labour Organization (ILO), based on considerations of maternal health and infant wellbeing.

“China is at 14 weeks and Singapore is at 16 weeks, so we think it is time Hong Kong stepped up to the plate. Hong Kong also provides for only three days of statutory paternity leave.”

She continues: “What’s interesting is that many countries and companies (like Facebook, Netflix and Microsoft) have ditched the traditional concept of maternity and paternity leave in favour of gender neutral parental leave which gives parents the choice which one of them will take the time off to care for the baby.”

As many as 61 countries allow at least 14 weeks leave on full pay, according to the ILO, the average in Asia is 12.7 weeks, while the UK (50 weeks), Australia (52) and Sweden (68) are among countries that permit parents to share the allowance and thus the duties. Funding varies, with full pay typically available only for part of the leave.

woman working with a baby

Maternity benefits in Hong Kong: What am I entitled to?

Certain conditions, such as length of employment and contract status, must be met to receive statutory maternity benefits, with maternity pay amounting to four-fifths of your average daily pay for the 12 months prior to going on leave.

If you and your employer agree, you can wait until up to two weeks before your expected due date to go on leave. Otherwise, you should start four weeks before that date. You can’t be dismissed between giving your employer notice and when you return from leave, except for serious misconduct or if you are on probation.

Maternity care in Hong Kong: What to expect

Government-funded health care includes pregnancy check-ups, tests and ultrasounds, labour, birth care and aftercare. A doctor will only deliver the baby if the case is high risk, and you may not know the doctor or midwife attending you.

In the private health system, the same doctor will care for you throughout pregnancy and in a hospital of your choice. The father is also allowed to join the mother throughout the whole process, not just in the birthing room.

Midwife and commentator Hulda Thorey says: “The government system is capable of giving excellent care for low cost and good safety. The major complaints have mostly to do with inefficient use of time, lack of communication skills and flexibility.

“Generally speaking, if you have insurance for a private hospital birth, fully covering any care, it is well worth finding a doctor and hospital that suits you. You just need to identify in advance what exactly you are looking for, and what is actually available in each one of them.”

International maternity insurance plans will normally allow you to choose your own doctor or hospital, but in busy Hong Kong you may need to decide and book as soon as pregnancy begins.

Insurers will impose a minimum 10-month waiting period for cover to begin, so the health insurance policy must be in place before you are pregnant. Basic policies may only include cover for complications in pregnancy, with fuller policies covering routine maternity care and childbirth, emergency surgical procedures, as well as cover for newborns, with varying levels of protection.

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Expat life: managing stress in Hong Kong

Becoming an expat in Hong Kong is an exciting prospect, but living in the city can bring mental challenges and worries for expats. How can you manage the potential stress of making a move?

Living and working in Hong Kong can lead to stresses associated with the lifestyle and environment of the city. For example, global research by Swiss banking group UBS has found that Hong Kong residents clocked up the longest working hours anywhere – at 50.1 per week, accompanied by just 17 days of annual leave.

As well as the stresses of working life, there can also be a whole set of domestic challenges in adapting to what will be a very different culture for many people – potentially affecting all family members.

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“When you consider that starting a new job and moving house are known to constitute some of life’s greatest stresses, it’s easy to see why being an expat can sometimes be so difficult,” explains Karin Sieger, a London-based psychotherapist who works with expats.

“They are literally having to undergo what would normally be individual experiences all at once. And that’s not counting the impact that taking your children abroad may have – or even choosing to give birth in a foreign country.”

Having previously worked in Hong Kong herself, Sieger, who is accredited and registered with the British Association for Counselling and Psychotherapy, now runs dedicated workshops for expats on the emotional challenges of either coming from or moving to other countries.

Seattle-based therapist Anita Colombara, who spent four years working in Cambodia with an NGO, adds: “Sometimes these challenges can negatively impact an expat’s emotional wellbeing and their relationships with family and friends – or lead them to develop unhealthy behaviours to cope with it all.”

Understanding the issues to manage stress

While people who may have had problems in the past should think about their wellbeing, Sieger recommends that people who do not usually consider their mental health should also contemplate the probable stress once they make the move.

“People can burn out a lot quicker when they’re living abroad, and expats need to realise that they might not be able to access the same level of support that they could expect at home – even if they’re working for the same employer.”

Colombara, who faced her own mental health challenges when working in Cambodia, realised she was not alone, and set up Remote Access Mental Health on her return to the US – which allows expats to undertake therapy via video conferencing, wherever they happen to be.

Hong Kong urban scene

Finding support

Having a support network in place is an integral part of maintaining good mental health, according to Sieger, who underlines that the transient nature of expat life means that it’s essential to keep in touch with a good base of people back home.

“It’s not uncommon for people to want to put a brave face on, in front of what is usually a limited community,” she says, “often for fear of being gossiped about or things getting back to their employer. That makes it all the more important that they maintain some sort of outlet.”

Colombara adds that seeking therapy in such a tight enclave can be awkward.

“Even if there is a professional therapist available, it is very likely they are already acquainted,” she points out, “making professional boundaries difficult to establish. The intimacy of an expat community can also make privacy challenging. However, I would say that the biggest barrier to getting therapy is really the denial that there are issues that need to be addressed.”

Tips for managing stress

Siegel recommends several self-help measures for any expat’s mental wellbeing, while online resources can also help:

  • Preserving continuity: If there’s something you enjoy doing – a sport, or certain hobby, for example – then keep doing it!
  • Establishing a daily routine: Having something that is known and familiar makes us feel good.
  • Learning something new: Try to find a fun activity or pastime that has a direct link to the country you’re in. It will help you feel a connection to the place you’re in and to bring something new to your life.
  • Setting some ground rules: Time differences can make it easy to fall into working out of hours. Don’t be tempted just to try and fit in – establish some firm time boundaries, stick to them and keep some quality ‘me’ or family’ time.
  • Consider using online counselling, and joining expat forums for tips, advice and contacts for potential support networks.

Available treatments

If you would like to seek guidance about any mental health issue, Sieger’s advice is to find a therapist who will look at what you want to achieve and outline the processes that you use.

As a rule of thumb, counselling tends to be short- to medium-term, whereas psychotherapy is used for people over a longer time frame.

“In large, cosmopolitan cities such as Hong Kong, mental health services are not normally difficult to access as long as people take the initiative to seek them out,” Colombara says. “My suggestion is to ask an international hospital or primary care doctor for mental health resources. There are also some well-resourced international churches or expat forums that could probably provide some good referrals.”

Expats should also check whether their health insurance policy includes cover for mental health services, to help with access to any professional services and treatments.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

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Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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