This is Why We Work With Exchange Students

We have worked with high school exchange students for 10 years now — 14 if you count the several years we were “just” host parents and not coordinators! Working with teens going through cultural shock and host families going through the excitement of learning about another culture can be exhilarating. It can be frustrating. It can, at times, be disappointing. This year, two of our 39 students have had to return home early — and we’re just halfway through the academic year. A few students in our group have changed host families, each situation being completely different. Several more students and host families have concerns we are helping to (hopefully…) resolve successfully.

So why do we bother?

We bother because of the relationships we develop with students (and host families) every year. Not every student becomes a friend for life; that would not be a realistic expectation. But enough do so that we see what the experience can do for them, their host families, their teachers, and others. Teachers understand; they teach for the students who care — and for those who eventually learn to care.

I’ve included here just a few examples of those relationships. These are students who “pushed back” and students who did not. The common thread is that after the fact, they could all see some of what they gained during their exchange. (I’ve changed their names for privacy reasons.)

  • Sean lived with us for about six weeks at the beginning of the school year while we found him a permanent home in our school district. During those six weeks, he learned that we loved good European chocolate and Haribo gummies. Every year since, he and his family have sent a small annual Christmas gift containing a box of chocolate and a couple of packages of Haribo treats. He and his parents include a Christmas card with a “happy holidays” note.

This year — five years later — Sean included a hand-written note:

“It now has been five years since you allowed me to stay at your home, and yet I still don’t know how to properly express my gratitude for your many acts of kindness, even though I do think that my English has improved at least a bit!

And even though I probably gave you quite a bit of sorrow with my lack of discipline, I hope I was also able to leave behind something positive (or a deeper appreciation of Haribo!). So, once more, I hope you are all doing well and your wishes come true.”

  • Maria faced some struggles in adjusting to life in the U.S., and had to change host families during her year. By the end of the year, though, this is what she had to say:

I graduated from an American high school that became my family throughout this year. Many people say I went on a vacation. All of those people are wrong. What I learned is not comparable to what a year of regular Italian school could have taught me. I learned the meaning of setting your mind to a goal and work to reach it, I learned how to be a great leader in the community, I learned to help the others in rough times, I learned that school is not just about grades and studying but also about getting involved and participating, I learned that you don’t need to have expensive bags and shoes to be a cool person. All you need is yourself and a lot of positivity to transmit to people. I learned that is not cool making fun of people, I learned how much joy can give you volunteering and supporting the special ones, I learned that you always have to learn….

  • Andrea lived in a small town in Oregon in a host family with two small children. As she left, she wrote:

The past ten months have been the best time of my life so far and never ever will I forget the memories I made here or the friends I’ve made. I love you all so so much and words cannot explain how much it hurts me to leave this wonderful place. … I know for sure that my way will take me back here sooner or later – after all, I have family here now and lots of amazing friends. I want to especially thank my family for having me this year and making me feel less like “the exchange student” but like “our family member.” … I will never forget how [my two little sisters] went from calling me their exchange student to their sister….They know I will always be their sister and I promised them that we will see each other again soon.

  • Ending with again, one of our own … Andrew constantly pushed back during his exchange year. He conveniently “forgot” house rules time and time again. We had a lot of fun, he got along with our boys, and we enjoyed having him around — those arguments could be spirited political discussions! But he argued all the time. Five or six years later, in a Skype chat on one holiday or another, Andrew said completely out of the blue:

I wanted you to know … I know how much you tried to help me. The things you said then, they make a lot more sense now. I just want you to know how much I appreciate it. It just took me a while.

So to our young friend Sean who is now (unbelievably, to a host mom…) 21 years old: We are doing well, and you have shown us that wishes do come true. One student, one teenager at a time, as expressed by a host parent after her student returned home at the end of her year:

… no matter where we all are, she remains family, [and] our mutual love and admiration continues. … Nothing changes. We are still family, a larger family than before.

Injuries and Illness While on an Exchange: What’s the Right Thing to Do?

Last year, one of the exchange students in our group had to return home to Norway two months before the end of the exchange year due to illness. Potential host parents ask us questions about this kind of thing: what happens if students get sick while they are here? Do I as a host parent have the right to take my student to a doctor? How do we deal with insurance? The short answers are that each situation is different. We thought we would share some of our experiences to show how this works in practice.

Things happen.

Exchange students are like anyone else. They break a wrist while snowboarding, sprain an ankle while playing soccer, get the flu, and are diagnosed with previously unknown conditions. Most of the time, they recover. A broken wrist or 15 stitches will cause short-term pain but are also just that: short-term.

Sometimes, however, their illness or condition cannot be adequately treated so far from home. Real life examples can easily show the differences:

  • Easy to deal with: William fell onto another skier while skiing with the high school ski team at the state competition. He needed 15 stitches. The clinic at the ski area called William’s host parents, explained the situation, confirmed his insurance information, and treated him for the injury. He had his stitches removed 10 days later at a local doctor’s office near his host family’s home.
  • Short-term worry, medium difficulty: Maria was vacationing with her host family in a Broken_right_hand_in_orange_castmountain ski area several hours away from the host family’s home when she broke her wrist snowboarding. Neither the host family nor the student had the student’s insurance information with them, causing some immediate short-term stress on the scene at the hospital; this was cleared up by a call to the student’s exchange program coordinator who provided the insurance information. The hospital spelled Maria’s last name wrong and input the insurance information incorrectly into the computer. This caused issues in the following weeks as bills began to arrive requesting full payment. The situation became more complicated because the host family signed forms at the hospital agreeing to be financial guarantors for the student’s bills (something you shouldn’t do if you can avoid it). The exchange program eventually was able to intervene and help straighten out the situation.
  • High level of short-term worry: Jorge slammed his head and shoulder on the ground hard in a rugby game. He had immediate pain and numbness in his arm and could not feel anything in lower legs or feet. As a result, adults at the scene called for a Life Flight helicopter to take him on an emergency basis to the hospital 10 miles away. Over the next several hours, Jorge slowly began to regain sensation in both legs. He continued to have difficulty in moving his left arm. Doctors conducted various tests over the next 12 hours; the hospital released him after a diagnosis of nerve damage. He recovered fully.
  • Previously undiagnosed condition, life-long management needed: Sophia complained of stomach distress over a period of several weeks. After a battery of tests, she was diagnosed with Crohn’s disease, a chronic inflammatory condition of the gastrointestinal tract. Crohn’s disease is a life-long condition, which can be managed with appropriate medication and supervision. But getting to a stable managed stage can take time, since not everyone responds well to any given medication or dosage. It became clear within a few weeks that Sophia was not responding well to the “easier” medication regime and that she would need to change to a more intensive (and more expensive) medical regime with possibly significant side effects. She had to return home two months before the end of her exchange year, missing her U.S. high school graduation ceremony and other end-of-year activities.
  • Serious condition, intensive medical intervention and family counseling needed: A day or two after New Year’s Day, Alexandra’s host parents called their coordinator to say they were worried because she seemed to have lost a significant amount of weight. They had weighed their student for a school sports information form, and thought the weight seemed low for her height and age. Comparing her current weight to the weight on the medical form the student had submitted to the exchange program prior to departure from her home country, the host parents realized Alexandra had lost 20+ lbs. Within a few days, a physician had diagnosed anorexia and strongly recommended that the student return home for treatment; indeed, the physician indicated that the student was on the verge of requiring hospitalization. Within two weeks, she returned home.

Insurance helps, but may need explanation

The U.S. Department of State requires that all J-1 visa exchange students carry adequate medical insurance. Exactly what the insurance coverage will cover is not always easy to determine on the spot. This can be difficult for foreign teens and their parents to understand, since they are used to very different healthcare systems.

Lifeflight* Bills from doctors, labs, and hospitals often arrive in the mail before insurance companies have processed claims. Jorge, our rugby player, saw the $21,000 Life Flight helicopter bill when it arrived at his host family’s home before the insurance company processed the claim. He had difficulty understanding that he and his parents did not need to panic, that this was purely a ‘crossing in the mail’ issue.

* Requirements that there be a financial guarantor can create administrative confusion and worry. The clinic treating student William on the mountain for his skiing accident tried to pressure the host family into agreeing to be financially responsible. This was not an unreasonable request from the point of view of the clinic billing administrator, but it’s not a situation we want host families to face. We generally recommend that host families ask the medical facility to use either the exchange program’s contact information or that of the student’s natural parents. This approach may not always succeed, since medical providers may not understand the relationship between an exchange student and host parents. If this happens, host parents should immediately follow up with their program to help prevent it from becoming a major issue. In William’s case, the host parents were able to point out to the clinic that they were not the student’s legal guardians and had no legal relationship. The clinic agreed to put the student’s natural parents contact information on the documents.

* The concept of co-payments or deductibles can be difficult for students and natural parents to understand. The concept of co-payment may seem obvious to American readers, but may come as a surprise to exchange students and their families, who are unfamiliar with the U.S. medical system. We have had many conversations with students and sometimes their parents as well. We try to walk them through an explanation of why they have to pay this or that balance on a medical bill even though they have paid for medical insurance.

What do you need to know?

We can recommend basic strategies to be prepared. For one thing, all adults involved with exchange students should encourage students from the day they arrive to talk to someone – host parents, local coordinator, a teacher or counselor at school, someone from their program’s main office – if they feel ill or injure themselves. Teens often ignore symptoms. They don’t believe a swollen ankle is a big deal (the swelling will go down, it’s nothing) and a stomach ache will go away (it’s just something I ate). They may be embarrassed by their symptoms, and it can be difficult to share personal feelings or medical symptoms with people they do not know well.

Additionally, host parents should keep an eye on their student’s general health and eating habits, as well as on any medications their student may have brought with them from home. A student’s diet may have changed from what he or she normally ate back home. Students worry about gaining weight and may develop poor eating habits as a result. Host parents may feel uncomfortable about compelling teens they do not yet know well to eat a balanced diet, feeling that they are nagging. Host parents can help students feel more comfortable about talking about personal issues such as medical symptoms by themselves talking about personal issues and showing their student that it’s ok to talk about it. Host parents should not hesitate to take the student to a doctor; this should be an adult decision, not left up to a teen who may not understand potential illnesses.

We don’t like it when our students have accidents or get sick. Coordinators worry, program staff members worry, host parents worry, and of course parents back home worry. But the fact that life doesn’t always take the direction we want should not stop parents from letting their teenaged and young adult children from studying abroad and doing a cultural exchange. Indeed, students with pre-existing medical conditions or permanent physical disabilities should also consider study abroad – if under control, it does not stop them from being accepted into an exchange program. Thinking about the “what if” situations shouldn’t stop families from hosting a student, either; the families who hosted the students profiled above had strong relationships with their students. Jorge, Sophia, and Alexandra all have come back to visit their host families. If we stop doing things just because something might happen, we would never see anything, do anything, or learn anything.

All students’ names have been changed to protect their privacy. Photo credits: Helicopter:; hand in cast: pixlaw [CC BY-SA 3.0 (]; health image: Lafesta