Your Health
Health Care in The United States
Americans are generally very health-conscious. From the foods they eat to the exercise regimens they follow, most Americans spend a good deal of time trying to avoid becoming ill. Nonetheless, illness and accidents are sometimes unavoidable. It is important for you to learn about health care systems in the U.S., as they can often seem complex, bureaucratic, and very confusing.
There is a broad range of health care services on campus and in the local community. Depending on your needs, circumstances and status at Rutgers, some of these services might be provided by the university at no extra cost to you. For other services, you may be required to pay the full amount. This chapter attempts to introduce you to the range of services available to you. Do not wait until you become ill to learn about these services; learn where and how to get care before you are in a situation which requires medical attention. Join in a health center tour offered during new student orientation, drop in a health center during regular hours to see what is available, or attend one or more of the many health-education programs offered throughout the academic year.
In reading this chapter, please take particular note of the section on health insurance. All students in F or J immigration status
and their accompanying dependents, even children born in the United States are required to have adequate health insurance
coverage at all times. Medical care in the United States is extremely expensive; many people are left permanently in debt to a
hospital or physician after receiving medical services for which they have no insurance.
Maintaining good health is a process which has physical, emotional, and spiritual dimensions, each needing regular attention for people to remain healthy.
Getting enough sleep, eating well, exercising, and practicing preventive health care are all-important parts of physical wellness. Attending to personal hygiene, avoiding stress, taking time for relaxation, and maintaining friendships promote emotional health. Maintaining personal -- and for some religious -- values and a sense of perspective are aspects of spiritual wellness. All of these components contribute to good health.
Preventive care is one of the most important facets of wellness. Eating a balanced diet, exercising, self-examinations, regular
check-ups, practicing safe sex, and even using automobile seat belts all contribute to good health. One's attitudes and
behaviors play a major role.
The Department of Health Education, located at 11 Bishop Place, Hurtado Health Center, provides programs on health related concerns. Services include seminars and workshops on nutrition, stress management, AIDS, contraceptives, alcohol and other drugs, acquaintance rape prevention, smoking cessation, and promoting respect for diversity, including issues of racism, sexism, and heterosexism. For further information call 932-7710.
Tuberculosis
Tuberculosis (TB) is estimated to affect one-third of the world's population. Until the last decade, its prevalence was declining in the United States.
Tuberculosis is caused by a bacterium which can infect any part of the body. Since the bacterium is contagious and can be carried in the air (e.g., through coughing), its most common initial site in the body is the lungs. Symptoms of TB may not appear for a month to a couple of years, but can include persistent coughing, a chronic low fever, hoarseness of the throat, weight loss, and chest pain. Without treatment, TB may cause pleurisy or deterioration of the lungs and can destroy other tissues of the body. About 5% of the U.S. population are "asymptomatic," meaning their body carries the bacteria and can spread it to others, but they experience no symptoms. Many are unaware they have the disease.
Transmission: Because it is spread so easily, tuberculosis is increasing in populations where there is crowding or inadequate medical care, such as among the homeless, prisoners, and intravenous drug users. Persons with HIV (AIDS) are more susceptible to TB, since their weakened immune system is unable to protect itself from the bacteria. People from countries where there is a high TB incidence are also more likely to have the TB bacteria.
Prevention: Prevention of TB in the U.S. is centered on early identification and treatment of active cases, drug therapy for asymptomatic carriers, and prevention of transmission to others. The test for present or past infection ("PPD.") involves a small injection under the skin. If a medical clinician finds no redness or raised skin at that site 48-72 hours after the test, it is interpreted as "negative" (i.e., no TB present). Many people from all parts of the world have received a vaccine to prevent TB, called "BCG." This vaccine is no longer recommended for most people and those who have received it may falsely test positive on the PPD test. For these reasons, their results are carefully evaluated by a clinician, and some may be required to have a chest x-ray to clearly identify the presence of the TB infection.
Persons with active TB and carriers will be prescribed inexpensive medicine that they must take on a specified schedule, usually lasting 6-12 months. It is essential that the medicine be taken exactly as directed and for the full duration of time, otherwise the infected person may infect others unknowingly, or their own infection may progress.
The Rutgers Student Health Service recommends that all students have the PPD test for TB. It is especially important that new
international students be screened for tuberculosis. Each of the Rutgers health centers can provide this test for a small fee, and
any follow up care if necessary. For more information, call a Rutgers Student Health Center: Hurtado, 932-7401,
Busch/Livingston, 445-3250, or Willets, 932-9805.
Hepatitis B
The hepatitis B virus (HBV) infects people of all ages. It is one of the fastest-spreading sexually transmitted diseases and can also be transmitted by sharing needles. In the U.S., about 300,000 new cases appear each year. It is a chronic viral infection which ultimately affects the liver. The virus is found in almost all body fluid is much more easily transmitted than HIV (the virus associated with AIDS).
Symptoms: Early symptoms of the disease include nausea, fatigue, fever and loss of appetite. After several days or weeks, dark urine or jaundice may appear. The infected individual may also feel extremely fatigued and weak.
Individuals with untreated hepatitis B are at risk of developing serious, long-term liver diseases -- such as cirrhosis of the liver or liver cancer -- that can cause serious complications or death.
Transmission: The virus is present in blood, semen, and other body fluids. Transmission usually occurs during blood-blood or semen-blood contact, sexually or by sharing needles. Individuals at greatest risk are those who share needles for injecting drugs, tattoos, acupuncture or ear piercing; engage in unprotected intercourse (anal, vaginal or oral); work closely and frequently with the body fluids of infected patients, e.g., health care workers.
HBV is not transmitted by casual contact, airborne routes, contaminated food or water. The risk increases only when there is direct contact with body fluids.
The hepatitis A virus, which is different from hepatitis B, can enter a person's body when he or she eats or drinks something
contaminated by someone who has the disease. Symptoms of hepatitis A usually appear suddenly but are not followed by the
chronic problems that HBV can cause.
Prevention: The best method of prevention is immunization with the inactivated virus. This vaccine costs approximately $160-225. If unvaccinated individuals are exposed to Hepatitis B they may also receive another drug (gamma globulin) that can lessen the likelihood of illness. Since there is no cure, the vaccine is strongly recommended for people at risk. The HBV vaccine consists of three injections over a six-month period.
Other ways of preventing infection include avoiding unprotected and high risk sexual activities and avoiding the sharing of needles or any other skin-puncturing device.
For more information, contact the Department of Health Education at 932-7710, or any one of the Student Health Centers.
AIDS
AIDS, Acquired Immune Deficiency Syndrome, is the late stage of an infection associated with a virus (Human Immunodeficiency Virus, "HIV"), which suppresses the body's immune system. HIV attacks the white blood cells that help protect the body from infection. People who develop HIV infection and AIDS are vulnerable to serious illnesses that are not a threat to people whose immune systems are functioning normally. People have been living ten or more years with HIV infection, sometimes without having symptoms of illness.
Transmission: HIV is transmitted when one person is exposed to HIV through blood, semen, or vaginal secretion-to-blood contact. HIV is transmitted from one person to another by having the virus (located in the infected person's white blood cells) come in contact with another person's blood supply (for example, through microscopic cuts in the rectum or vagina, or through intravenous injections). Highest risk behaviors for HIV infection are sharing intravenous needles such as for drugs infected with HIV; sexual intercourse with multiple partners; being born by a woman infected with the virus.
Compared to many other viruses, HIV is weak and easily destroyed outside the body. The virus is not spread by any kind of casual contact (for example, sharing drinking glasses, swimming in a pool, sneezing). It is spread by receiving blood or blood products or infected semen/vaginal secretions.
Prevention: To prevent becoming infected with the virus that causes AIDS, the Rutgers Student Health Service recommends that you abstain from all high-risk sexual activities; avoid unprotected sex; choose lower-risk sexual activities (kissing, hugging) in order to reduce your risk; never mix alcohol or other drugs with sex; and don't use intravenous ("IV") drugs or share needles for any reason.
If you think you might have AIDS or be at risk for it, call the nearest Rutgers Student Health Center to get information about
the HIV antibody test. For more information, call the Rutgers AIDS/HIV Task Force at the Department of Health Education
(908/932-7710).
Health Care Facilities at Rutgers
The Rutgers Student Health Service provides basic on-campus health care in three locations on the New Brunswick/Piscataway campuses: Hurtado Health Center, 11 Bishop Place, College Avenue Campus, 932-7401; Willets Health Center, Nichol Avenue, Douglass College, 932-9805; and Busch-Livingston Health Center, Hospital Road and Avenue E, Livingston Campus, 445-3250. It is always best to phone ahead for an appointment, but walk-ins are accepted. You may use any of the centers, but you are advised to establish a permanent record at only one of them to ensure continuity in your health care program.
Because they are automatically billed for the university's student health insurance plan, which includes a mandatory health service fee, graduate and undergraduate students in F or J status are automatically entitled to use the Rutgers Student Health Service (see following section on Insurance/Requirements for International Students). All other students except those in University College registered for 12 credits or more also are automatically billed for the student health/insurance fee and may therefore use the service. Students not in F or J status who are registered for fewer than 12 credits or who are in University College who want to acquire health service benefits must complete an application and pay the health fee at the Student Health Insurance Office at the Hurtado Health Center.
Among the services available on campus are treatment for minor problems, e.g., infections, accident-related injuries, flu; gynecological care; substance abuse counseling; health education; physical examinations; laboratory tests; x-rays; orthopedic care; immunizations. The Rutgers Student Health Service maintains a directory of its staff members who speak languages other than English. If you would rather not discuss your medical needs in English, ask if you can be referred to someone who speaks your native language.
Referrals to outside specialists are made when the university services are insufficient for your needs. You must pay the outside
specialist yourself, but if you have adequate insurance coverage, some of these costs would be reimbursed to you by the
insurance company.
In the United States each individual is responsible for paying the costs of his or her own medical care. Except for certain low income U.S. citizens and permanent residents, no government assistance is available for those people who need care but cannot afford it. The cost of medical care is the fastest rising expense in the U.S. today. One night's stay in a hospital can cost over $1,000 and a routine procedure such as an appendectomy can result in combined doctor and hospital bills of several thousands of dollars. Since most Americans cannot afford the high cost of medical care, they rely on insurance in medical emergencies. For an international student, one serious illness, injury, or catastrophic medical emergency can mean financial ruin and spell the end of educational dreams. Medical insurance is an absolute necessity in the United States.
Most students have been healthy all of their lives and believe that they will remain so throughout their stay in school. Though
most are fortunate enough to avoid serious illness and injury, some are diagnosed with serious illnesses and others suffer
life-threatening injuries while they are in college. No one can predict who will remain healthy and who will not, and after an
individual becomes ill or has an accident, it is no longer possible to obtain medical insurance which will cover that illness or
injury, called a pre-existing condition. In fact, if the illness or injury is severe enough to require long-term care or to affect
one's general health, at that point it may not be possible to purchase any medical insurance at all.
Requirements for International Students
Like many colleges and universities in the United States, Rutgers requires international students to purchase health and accident insurance. In issuing certificates of eligibility Forms 1-20 and IAP-66, the university certifies to the U.S. Departments of State and Justice that it has verified the financial resources of newly admitted students and that these students have sufficient funds to meet their personal living expenses while studying at Rutgers. Since most students could not pay large and unexpected medical bills, as a condition of enrollment international students are required to have medical insurance.
At Rutgers, all students in F or J immigration status are required to purchase the university's basic and major medical insurance plan. Teaching and graduate assistants with full employee benefits are exempt from purchasing the major medical portion of the plan, but like all full-time Rutgers University students are billed the student health fee, which includes the basic portion of the plan.
The student health fee supports the Student Health Service as well as providing health insurance coverage of $3,500. This level of coverage is adequate for routine medical treatment but would not cover the cost of care for a serious injury or illness. The major medical insurance portion of the university's plan provides coverage of $50,000. To find out the exact rates for the insurance, you can contact the Center for International Faculty and Student Services.
Visa dependents of F and J students must also have health insurance. Prior to issuing a new immigration document for
dependents or the signing of an existing document, the international student adviser will require evidence that basic and major
medical insurance has been purchased for the dependents. Dependents may be covered in one of two ways:
Rutgers University spouse and dependent insurance: The same basic and major medical plans which covers you as a student are available for your immediate family. Costs vary, depending upon specific coverage. The Rutgers Student Health Service and the Center for International Faculty and Student Services have specific cost information and enrollment forms. Although this may seem like a great deal of money, it is considerably less expensive than buying coverage directly from an underwriter and it is less expensive than most group plans available to international students in the United States. Most important, it is but a fraction of the cost of medical care. One overnight stay in a hospital can cost $1,000 or more.
Health insurance through the Rutgers University Benefits office: Students with full-time, academic- or calendar-year teaching or graduate assistantships receive comprehensive health insurance coverage for themselves and their dependents as part of their benefits packages. Information on the plans available is provided through your employing department.
Note: Although it is Rutgers University policy that students in F status have a minimum of $50,000 in health insurance
coverage, individuals in J-1 or J-2 status are required by law to have health insurance coverage of at least $50,000. Willful
failure to maintain a policy in effect results in loss of exchange visitor status in the U.S.
Community Health Care Facilities
If you are not a member of any specific health care program such as the Rutgers Community Health Plan, you can obtain the
most thorough health care through the services of a private physician. The Rutgers Student Health Service has a referral
program and can give you the names of general and specialist physicians. You can also find a physician by looking in the
Yellow Pages under "Physicians." Health insurance plans will not cover routine "check-ups," eye glasses, or dental work, but
will cover partial payment for certain specific health problems.
Hospital Emergency Rooms
Every hospital has an emergency room. Services provided are strictly for emergencies and should not be used for minor problems which can be attended to by a private physician or at any of the student health centers. There are three hospitals in the immediate vicinity: St. Peter's Medical Center, 254 Easton Avenue, New Brunswick, 745-8525; Robert Wood Johnson University Hospital, One Robert Wood Johnson Place (off Somerset Street), New Brunswick, 828-3000; and John F. Kennedy Medical Center, James Street, Edison, 321-7601.
Emergency rooms do not take appointments. In a true emergency, drive (if you can) to the emergency room nearest you. If you are unable to drive, phone the emergency room or dial "911" on the nearest telephone, give your exact location, a brief description of the situation, and ask for an ambulance to come immediately.
In a health emergency on-campus, call the office of Public Safety (932-7111), tell them the situation and request help.
Community Clinics
There is a variety of health clinics in most U.S. communities. The type of services offered by each will vary, as will the costs. Some clinics will let you pay on a "sliding scale," which means your costs will be determined by your financial situation and your ability to pay. Some clinics have comprehensive services; others are for specific health problems only. Following is a sampling of the clinics in the New Brunswick area.
Planned Parenthood, 211 Livingston Avenue, New Brunswick, 246-2404, offers pregnancy testing, birth control information, referral services, and contraceptives as well as routine gynecological examinations. Fees are charged on a sliding scale. This very reputable organization often receives public funding for services provided and is located in offices throughout the state and nation.
Eric B Chandler Health Center, 277 George St, New Brunswick, 235-6700.
Robert Wood Johnson Clinic, One Robert Wood Johnson Place, New Brunswick, 937-8761, offers preparation classes for childbirth, dental services, family medicine, and many other special areas of health care.
Catholic Charities, 24 Abeel Street, New Brunswick, 745-9800, provides no-cost health maintenance services for
low-income families.
Personal and Psychological Counseling
Most students experience conflicts and anxieties severe enough at times to interfere with their learning and personal growth. These concerns may be of a personal or an educational nature. Personal and psychological counseling is available to help you understand and resolve such problems.
Some international students hesitate to use counseling services because the practice of sharing emotions and personal
experiences with a "stranger" is culturally unacceptable. No one at Rutgers University will ever force you to seek counseling
assistance for your personal problems, but please be aware that within the context of American culture, such professional
assistance is not viewed in a negative fashion. Counseling professionals do not "judge" you, nor do they ever tell anyone else
-- not even their professional colleagues -- anything you tell them in confidence. Counseling professionals guide you toward a
more complete understanding of the nature and root of your difficulties, and help you learn the coping skills you need to
resolve or accept them.
Counseling Services
There are several different kinds of psychological services available on the New Brunswick/Piscataway campuses. The largest services are the counseling centers connected with the undergraduate colleges; the services of these centers are also available to graduate students. Counseling Center locations:
Rutgers College Counseling Center, 50 College Avenue, 932-7884
Cook College Counseling Center, Cook Campus Center, 932-9150/8982
Douglass College Psychological Services, Federation Hall, 932-9070
Livingston College Counseling Center, Tillet Hall, 445-4140
In addition, because TAs and GAs are regular employees of the university, they are eligible to use the services of the Personnel Counseling Service at Livingston Theater on Livingston Campus. An appointment must be made in advance by calling 445-7539/7540. Services are free to faculty, staff and immediate family, and strict confidentiality is maintained in accordance with ethical standards and the law.
Each counseling center offers individual and group psychotherapy, and sees couples who wish to explore issues concerning their relationship. Most counseling is short-term, though each center -- Cook in particular -- sees some students for longer-term therapy. Referral is also available to other agencies or private practice when ongoing psychotherapy is needed and desired. Support groups for graduate students are available at several of the counseling centers, and there is a special group at the Rutgers College Counseling Center for students working on their dissertations.
University College offers counseling through the Office of Counseling and Student Affairs, 14 College Avenue, 932-8074.
Psychological services are also available through the Rutgers Student Health Service for students who have paid the health/insurance fee. Services include psychiatric consultation, evaluation, and treatment, crisis intervention, and short-term psychotherapy. For information visit one of the health centers or call Hurtado Health Center (932-7827), Willets Health Center (932-9805), or Busch-Livingston Health Center (445-3250). In addition, the Student Alcohol Assistance Program at Hurtado Health Center offers help to students for whom substance abuse is a problem as well as groups for Adult Children of Alcoholics. Services are free and confidential. For information call 932-7976.
Psychological services are provided at a fee, based on a sliding scale for therapy and counseling services to students through two training clinics on campus, where long- and short-term psychotherapy and marriage counseling are conducted by graduate students under supervision: the Psychological Clinic of the Graduate School of Applied and Professional Psychology (GSAPP), Psychology Building, Busch Campus, 445-6111 and the Center for Individual Development in the Graduate School of Education (GSE), Seminary Place, College Avenue Campus, 932-7496. The GSAPP Clinic also offers family therapy, and the GSE Center also offers career planning. Some services at GSE are offered by faculty, as well as by advanced graduate students.
Services for a fee, often based on a sliding scale, are available through the local Community Mental Health Center (call 463-4420 for information), and therapists in private practice. Referral to these services can be arranged through the campus counseling centers and health centers. The Community Mental Health Center also provides a professionally staffed emergency service available 24 hours a day for people experiencing personal difficulties. The number is 463-4424.
Faculty, teaching and graduate assistants, and staff, as well as members of their immediate families, can receive confidential free short-term individual psychotherapy and long-term group therapy for personal, marital, or work-related problems, or problems related to alcohol and drug abuse, through the campus Employee Assistance Program (EAP): Rutgers University Personnel Counseling Service, Livingston Theater, Livingston Campus, 445-7539/7540.
Coverage for private mental health service is provided through the standard university employee health insurance programs,
but the coverage varies significantly from plan to plan.
Peer Counseling and Referral Services
There are several peer counseling centers on campus set up by students for students. Student peer counselors are compassionate volunteers, carefully screened and trained to deal with any number of concerns. All counseling centers can be contacted by telephone, and are available for people to drop in and talk when they are open (call ahead for current hours).
Two peer counseling centers (56 Place, 56 College Avenue, 247-5555, and Gatehouse (Douglass/Cook), 932-9098 are for any callers. Students call them with concerns ranging from problems with roommates to other more serious anxieties, or just requests for information about where to go to solve a problem.
The Women's Support and Resource Center, 56 College Avenue, 828-7273, offers a phone line and conducts programs on topics of concern to women.
The Rutgers University Bi-sexual/Lesbian/Gay Outreach Hotline, Rutgers Student Center, 932-7886, provides lesbian/gay-related information and peer counseling to those who request it.
A Glossary of Common Health-Related Terms
Allergy, allergic to: if you become ill after taking certain medications, you are allergic to those medications.
Bandage: a cut is covered with a bandage to keep it protected. A small bandage is often referred to as a "band aid."
Check-Up: even if you are not sick, it is a good idea to visit a physician annually for a check-up, or a routine examination. (These are not mandatory in the United States.)
Chiropractor: a trained professional who adjusts the joints, particularly the spine.
Clinic: a health care service open to the public for a reasonable fee.
Epidemic: when many people get the same illness at the same time, it is an epidemic. During winter, we often have a flu epidemic.
Examination: any time you visit a physician you are given an examination so that he or she can determine the nature of your health needs.
Fever (also called a "temperature"): an increase in body temperature, often accompanied by chills and exhaustion.
First Aid: a series of techniques and procedures designed to give temporary relief in the event of an accident or sudden health problem.
Flu (influenza): refers to a variety of illnesses which occur most often during winter and which generally cause fever and exhaustion.
Gynecology: the branch of medicine related to women's physiology and health.
HMO (Health Maintenance Organization): HMOs offer a comprehensive range of services at no cost or for a nominal fee to members who pay an annual membership fee.
Immunization: an injection or a liquid taken orally which prevents individuals from getting certain diseases, such as polio.
Internist (formerly called a "general practitioner"): a doctor who specializes in general internal medicine.
Major Medical: comprehensive insurance coverage; includes most accident, illness and hospital-related costs.
Nausea (nauseous): feeling sick to your stomach.
Paramedic: an individual who is trained to administer temporary health care in emergencies. Ambulances are staffed by paramedics.
Pharmacy (colloquially, "drug store"): the store in which you purchase prescribed medicines and some non-prescription medicine.
Physical (also "check-up"): a comprehensive health examination.
Physician: medical doctor
Prescription: a doctor who prescribes special medicine for your needs writes you a prescription on a piece of paper. You take this to the pharmacy to get the medicine.
Specialist: a physician with a particular area of expertise and training: gynecologists treat women, pediatricians treat children, ophthalmologists treat eye problems, etc.
Therapy: any structured program of health treatment, e.g., psychological or physical therapy.