Universal medicine for travelers

January 17, 2013

When Jessica MacKenzie Murthy needed medical attention in Bangalore for three bouts of food poisoning, a sinus infection and one pregnancy, she didn’t rush to the nearest ER. With a clear head often absent in emergency situations, she bypassed the public hospitals for private clinics and, once admitted, eyeballed the facility for proper hygiene.

En route to one appointment, she and her husband witnessed a doctor’s unsanitary behavior on a traffic median. In the examining room, Murthy politely asked the physician to slip on gloves or wash her hands. Thousands of miles from home, the American visitor was both the patient and the health-care advocate — for herself.

“You have to prepare very differently” for getting sick abroad, said Murthy, an Alexandria resident who lived in India for two years in the mid-2000s. “Hospitals can be zoos in other countries. Nothing works quite like it does here in the States.”

Before leaving on a trip, most travelers prepare for what they imagine as the worst: rain, sunburn, boredom. The remedies for these potential inconveniences are simple: Throw in a slicker, a bottle of sunscreen and a heavily downloaded Kindle, then slam the lid shut.

But sometimes the setback is more serious than a lobster-red nose. What could ail you? Food poisoning, a broken limb, a deep laceration, typhoid, dengue fever, malaria. And what can fix you? Proper medical care, no matter the continent, country, city or mountain village.

Depending on the malady, you could self-medicate with the proper pills, lotions, bandages and rest. But when the illness exceeds your CVS medical training, you’ll need to seek professional attention. A scary concept in an alien land, but done right, the experience can be painless.

To ease the ouch of mind, body and budget, we sought advice from travel medical experts on how to navigate international health-care systems as foreign and chaotic as Bangkok’s street-food scene. The professionals offer tips for each step of the process, from the preventive stage to the unwell phase, when no amount of apples (or bottled water) will keep the doctor away.

An insurance safety blanket

On the comments page of InsureMyTrip.com, a travel insurance aggregator, travelers gush about how travel medical insurance gave them “peace of mind”; “fortunate” and “felt very comfortable” were also popular words. In the first 100 of 1,466 responses, not a single person related a negative story involving an injury or a claim. Nor did anyone complain about wasting money for an unused service.

“There’s the ease and then there’s the cost control,” said Bruce Kirby, president of the U.S. Travel Insurance Association. “The premiums are so small because the occurrences are so small.”

When you travel without insurance, you have to pay for all medical expenses out of pocket — sometimes up front, in cash. In the case of an evacuation, which can cost several thousand dollars, those pockets had better be coal-mine deep. Those with insurance, by comparison, don’t have to worry about smashing the piggy bank for massive expenditures. Depending on the plan, the company will dip into its own coffers and cover your bills like a generous benefactor.

David Shlim, president-elect of the International Society of Travel Medicine, spent 15 years working at a medical clinic in Kathmandu. The physician knows the life-saving advantages of insurance. He recalled the tale of a Dutch tourist who arrived at the Nepalese facility with black spots inside his cheek. The medical care workers diagnosed blood blisters caused by a lack of platelets, a life-threatening condition. The patient’s insurance company responded to the emergency with an air ambulance that transported blood from Singapore to Kathmandu and retrieved the patient for a transfusion. Tragedy averted.

To determine whether you’re a good candidate for travel medical insurance, Peter Evans, executive vice president of InsureMyTrip.com, suggests that you first check your U.S. medical insurance. If your plan covers health incidents abroad, including evacuations, then skip to the next section of this article. If it doesn’t, keep reading.

When choosing a plan, you need to factor in such variables as your destination (remote and rural or modern and urban), planned activities (strolling or scuba diving) and your age and personal health, specifically any preexisting conditions. You can also choose between single- and multi-trip coverage, depending upon how often you spin the globe.

For the most basic plan, the cost will equal your daily Starbucks coffee-and-scone fix — from $3 to $8 a day. For example, Evans, who’s 52, calculated that for a three-week international trip, he would spend $58 on a plan that would pay up to $50,000 in emergency medical protection and up to $500,000 for an evacuation.

Apparently, peace of mind is a bargain.

“It’s probably one of the most unsettling things to be ill in a foreign country,” said Phyllis Kozarsky, a travel health consultant for the Centers for Disease Control and Prevention, “and there’s nothing sadder than being in dire straits and having to pay $50,000 to $100,000 for medical care.”

Kozarsky has experienced the discomfort of ailing abroad and the disappointment of a ruined trip. Soon after arriving in India in 1987, she succumbed to illness and had to fly home for treatment.

“I did everything wrong that you could imagine,” said the professor of medicine and infectious diseases at Emory University in Atlanta. “I was outside at night in shorts. I had no access to clean water. I had holes in the screen and an old air-conditioner. I ate anything. I was a high-risk individual.”

Physician friends of her Indian sponsor family diagnosed her symptoms as pneumonia, diarrhea, dehydration and an unconfirmed case of Legionnaire’s disease. Kozarsky did not have supplemental travel health insurance, but she had connections, which absolved her from the quest for outside medical care.

The flip side: If you buy insurance, you gain connections.

In addition to easing the financial strain, travel medical insurance also pairs the patient with an assistance company that will provide support from the first distress call to the final discharge. The advocate offers such invaluable guidance as pointing the patient to a reputable hospital and facilitating treatment by corresponding with the attending physicians.

No matter how great the care we get, sometimes we just want our mommy. After seven days of hospitalization, some firms will fly your mom, or another family member or a friend, to your bedside. Your favorite stuffed animal can come, too.

Playing doctor

In case of emergency, call 911, or the foreign equivalent of H.E.L.P. For non-urgent matters, dial yourself.

When mild health issues crop up, such as a persistent cough or food poisoning, you have the power to self-heal. But you’ll need the proper instruments.

“If people have the skills to self-treat for minor respiratory illness or diarrhea,” says Kozarsky, “it’s sort of empowering.”

Before you depart on your travels, the CDC consultant recommends walking up and down the pharmacy aisles, tossing in necessary items. Her kit, for instance, might include an anti-diarrheal such as Imodium, a painkiller such as Advil, bandages, steroid cream, cough medicine (tablet or capsule), a mild laxative and sleep aids. If you’re allergic to bee stings, pack an EpiPen; if pollen or other allergens tickle your nose, stock up on Claritin or another antihistamine. Also throw in extras of any medications you normally take at home, in case you lose a few or your return is delayed. And don’t forget the Cipro or Zithromax, prescribed antibiotics that can resolve a slew of stomach and respiratory ailments caused by bacteria. (Ask your doctor for instructions on use.)

If you’re parachuting into an exotic locale with such potential risks as malaria or typhoid, visit a travel health clinic for counseling and possibly an armful of vaccinations and a mouthful of medications. (The International Society of Travel Medicine manages the Global Travel Clinic Directory, a list of facilities around the world.) Travelers with chronic diseases or conditions should also consult with a travel health provider and share all the details of their trip, including the altitude. Thin air can bedevil folks with compromised respiratory systems, for example.

Despite extreme vigilance — frequent hand-washing, drinking only bottled water, abstaining from raw fruits and veggies — pesky viruses and bacteria may still scale your fortified walls. But if you’re patient, they’ll leave.

For example, food poisoning symptoms should pass within six to 12 hours, and untreated diarrhea typically improves within five days. In addition to taking intestinal medicine, sick individuals should stay hydrated with “safe” liquids, doctors say; serious dehydration can land you in the hospital.

Fever can be trickier to self-diagnose. If you are traveling in a malaria-free area, Shlim says to wait a day or so; if the fever exists, seek medical attention. However, if you are in a region where the mosquito-borne disease persists, hang up your stethoscope and flag down a real doctor.

Is there a doc in the host country?

There’s a right way and a wrong way to receive medical care while traveling internationally. Here is an example of how you should not do it.

A year ago in Havana, I was hobbling around the Cuban capital with a Snuffleupagus-size appendage puffy with fire-ant bites. (The accident — stepping on the insects’ low-rise home — had occurred in southern Florida.) I didn’t know how to find medical attention in a communist country that didn’t accept credit cards or provide ATMs. At the urging of another American traveler, I visited the hotel infirmary, where a nurse flipped me on my stomach and poked me with a needle. I spent the remaining days with an itchy, swollen foot and a throbbing posterior. For all I knew, she’d shot me up with vodka.

The lesson learned: You need to be well informed about where to go for medical help and what treatment you’re receiving. And maybe learn a few phrases in the native language, such as, “Is this going to hurt?”

For starters, travelers should tap into the fairy godmother resources offering medical guidance. For example, the Joint Commission, a nonprofit organization that certifies health-care facilities in the United States, has expanded to international hospitals and institutions. Its list covers countries from Austria to Yemen, with Brazil, China, Kazakhstan, Mauritius and many other destinations in between.

For more than a half-century, the International Association for Medical Assistance to Travellers has been on a mission “to coordinate an international network of qualified doctors and mental health practitioners committed to providing the highest standards of medical care to travellers.” Italian physician Vincenzo Marcolongo was inspired to create the organization after he assisted a distressed Canadian in Rome. The group provides a growing database of more than 400 clinics in 120 countries that agree to treat any member (free to join; donation much appreciated) for a set fee of $100 per office visit and $170 for a night call.

“We visit the doctors and have close relationships with them,” said IAMAT president Assunta Uffer-Marcolongo, the founder’s wife. “The traveler knows that he will not be overcharged.”

Health-care systems vary tremendously worldwide, as do hospital cultures. Shlim, for one, praises facilities in Thailand, such as Bangkok’s Bumrungrad International Hospital, which has garnered several awards for its quality service. In India, Murthy preferred private hospitals over the government-run options, even though her physician husband worked in a public institution. She found the private venues to be better funded and stocked with more modern equipment. Nonetheless, in certain cases, she said, patients would have to purchase their own supplies — sutures, saline solution and medications, for instance — in advance. Her recommendation: Bring cash and a gofer/friend who can run to the pharmacy for you.

Despite the diversity in systems, some universal tips do apply. Americans can often find familiar care at hospitals affiliated with universities, such as Johns Hopkins, or U.S. health-care centers, such as Harvard Health. Or look for places that cater to expats, business travelers or medical tourists. Kirby suggests contacting the U.S. Embassy for recommendations or asking a hotel concierge working at an international chain.

Of course, no one wishes to interrupt his or her holiday with a hospital visit. But to look on the bright side, sampling a country’s health-care system is a truly immersive experience. Too Pollyannish? How about this: You might have saved some money by falling ill abroad rather than at home.

When my friend Ed suffered a stroke in Mongolia, he paid less than $950 for a three-day hospital stay including a private room, around-the-clock nurses and an MRI. After he returned home, Ed received a bill from an American doctor who had been visiting Ulan Bator and had initially assisted with his care. The fee for the two-hour consultation was hundreds more than the entire hospital portion in Mongolia.

Have your own tale of sickness while traveling abroad? Share it in the comments section of this story here.

the health issue

Andrea Sachs (not the one who wears Prada) has been writing for Travel since 2000. She travels near (Ellicott City, Jersey Shore) and far (Burma, Namibia, Russia), and finds adventure no matter the mileage. She is all packed for the Moon or North Korea, whichever opens first.
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