The emergency room technician at the tiny hospital spoke no English, and I knew only a phrase or two of Spanish, so the first words we exchanged were Japanese.
"Honda?" he asked.
"Si, Honda," I nodded. The pain in my shoulder was leaking through a torn shirt sleeve and the bruise on my forehead was ripening into a small eggplant.
The diagnosis was easy: The ubiquitous red and white Honda motorbikes that tourists rent to reach this island's secluded beaches had nailed another novice, turning a travelogue into a lesson in getting medical care abroad.
An hour earlier I'd scotted past the hospital on the outskirts of the island's only village, scouting for snorkeling sites and trying to sort out the controls on the unfamiliar Honda. Twist the right handle grip to accelerate. Squeeze the right hand brake and push the left foot brake to stop. Kick the gear lever with the right foot to shift.
Or something like that...
On the second day of vacation, the fine points of motorbiking were not nearly as interesting as the beach, the sun and old acquaintances.
Isla Mujeres -- Island of Women. My friend Joe had been talking about the place for years, and even he admitted it had not yet been spoiled by the Mexican government's efforts to build its tourist industry in the Yucatan.
Across the inlet on the mainland are the high-rise hotels of Cancun where President Reagan met Third World leaders last fall. Cancun is Mexico's answer to Ocean City, a $100-million complex of gleaming modern resorts built with funds from the World Bank. Cancun didn't exist until a new airport was carved out of the jungle a decade ago, but now is Mexico's busiest and most successful tourist development.
But an hour away by aging ferry is Isla Mujeres, an old fishing port that has always drawn a few tourists. The biggest hotel and a couple of the restaurants on the island boast air conditioning, but there are still rustic huts where the hammocks rent for $3 a night. For $16 a day, you can get a nice hotel room within a stone's throw of the ocean and miles of empty beaches a Honda ride away.
Exactly as promised. We chugged bottles of Naranja soda from a thatched snack shop on the beach and headed back to pick up the snorkles and spouses.
I lost it on the first turn; I'm still not sure how. The Honda flipped into the fauna and I swan-dived into the sand.My glasses broke against my face as I hit, but the plastic lenses saved my left eye. The forehead didn't feel as bad as it looked, but the left shoulder was another matter. The left arm did not move.
Joe took care of the Honda, flagged down the first car that came along and in his Miami-Cuban Spanish managed to persuade the driver to take me to town.
That was lesson one on getting in trouble in a strange place: Don't be afraid to ask for help. The young Mexican couple drove several blocks out of their way to drop me at the hotel, a favor I'd never expect from a stranger in, say, New York City.
I'd spotted the local medical clinic on a Sunday night stroll around the village square -- a white-stuccoed building with posters condemning alcoholism and advocating birth control.
The family translator's college Spanish was good enough to get me past the receptionist and the young doctor's English adequate to explain that the arm was not broken, but the shoulder needed an X-ray. The doctor wrote a prescription for pain medication, penned another note for an X-ray and pointed us toward a taxi. No charge, he smiled.
By the time the taxi got to the hospital, the implications of being injured in a non-English foreign country began to sink in. My head was throbbing, my shoulder ached, my arm wouldn't move, I was still stunned from the spill and isolated by the language barrier. My confidence was not helped by the kitty litter box sitting inside the emergency room door.
Though my companions had both traveled frequently in Latin America, neither was fluent enough to tell me exactly what was going on. Communication would have been easier if I'd had a copy of a little booklet that's available free to Blue Cross and Blue Shield subscribers. Called "A Foreign Language Guide to Health Care," the booklet lists medical terms and phrases, likely to be exchanged by doctors and patients, in English, French, German, Italian and Spanish.
Without the Blue Cross medical phrase guide, I floated in a sea of Spanish while the X-ray machine snapped one shot, then another, until finally I caught a word: "fractura." It was the shoulder blade, explained the X-ray technician, whose name tag did not indicate he was a physician. I needed to see an orthopedist, on the mainland, he said, handing me the X-rays.
A nurse stuck a needleful of painkiller into my rear; my wife paid the equivalent of $55 for the emergency room visit. It was a bargain by Washington standards, where emergency X-rays can easily cost $100, but I unknowingly failed lesson two in overseas health care: always get a receipt. When I later made a half-hearted attempt to get reimbursement from my health insurance company, the claims clerk politely said no. "How can we reimburse you, if we can't verify how much you paid?" she asked.
What is best, both private insurance companies and Blue Cross stress, is to take an insurance claim form with you. There are Blue Cross hospitals in Hong Kong, London and some other foreign cities, but most foreign hospitals will not simply accept an insurance policy number for payment as U.S. medical facilities will. In most places, you'll have to pay the bill yourself, then submit an insurance claim when you get home. An itemized bill and receipt will help, and may be all you can hope for if the language is a problem.
None of this entered my numbed mind as we packed and made for the ferry.
Mainland medical care promised to be better. Cancun is a "new town" built from scratch in the past 10 years as a base for tourism development and boasts a modern hospital and several private physicians.
But finding an English-speaking orthopedist proved impossible. U.S. embassies and consulates have lists of English-speaking doctors and dentists and are the first place an American tourist ought to turn. But the nearest U.S. outpost is in Mexico City, too far away to do much good and probably unnecessary for a relatively minor injury in an area with good medical facilities.
An international physicians referal service is offered by Intermedic, 777 Third Ave., New York, N.Y. 10017 (212-486-8900) for $6 a person or $10 a year. A pocket-size directory of English-speaking physicians in 120 countries is available to persons who make voluntary donations to the International Association for Medical Assistance to Travelers, 350 Fifth Ave., Suite 5620, New York, N.Y. 10001 (212-279-6465)
Still seeking a doctor, we checked into the new and luxurious local Quality Inn (known as the Hotel Calinda in Cancun, but an affiliate of the Silver Spring-based chain) where staff members offered their aid. It took three referrals to find the doctor I needed: a recent graduate of a Mexico City medical school whose shingle identified him as a specialist in orthopedics and traumatology.
His skills were fresh, his patience with our sloppy Spanish reassuring, but his X-ray machine was an antique with a black crinkled finish that looked like it had come from Dr. Frankenstein's laboratory. Though U.S. X-ray technicians cower behind shields while the machine is in use, this doctor held the X-ray plate behind my back with one hand and tripped the switch with the other. Zap.
By now the fracture was showing clearly, a white line that began beneath my left armpit and ran up toward the center of my back. For a modest $40 fee, he immobilized the arm with an elastic bandage and wrote prescriptions for an anti-inflamation drug for the shoulder and a tetanus shot for my scratches.
The tetanus prescription was puzzling. Where do we get the shot? we asked. He patted his hip. We asked again and he pointed to the "pharmacia" across the street. The dose of tetanus antibodies came with its own syringe, but I was not about to have my wife stick me with a needle, let alone do it myself.
It was not until the next morning that I finally figured out another lesson in injuries abroad: When in doubt, call your family physician.
The $6 call home was just what the doctor ordered. There's nothing much to do for a broken shoulder blade but immobilize the whole shoulder and take it easy, I was assured. Neither wading in the surf nor trekking through the jungle to see the fabled Mayan ruins would be a good idea, but the greatest danger I faced was being bounced and jostled on the plane home.
Since I had purchased my flight on a cut-rate excursion fare, the Eastern Airlines reservation service warned that I'd have to pay full fare if I went home early. When I showed up at the airport with my arm in a sling, a black eye and a bruised forehead, however, the ticket agent did not ask for the extra fee.
Airline policy on such matters varies, but by pleading and wrangling you may be able to avoid paying a penalty for returning early. Charter flight passengers are more likely to get stuck for it. For many tourists, short-term trip cancellation insurance, available from most travel agencies, is worth the modest premium. Sometimes just finding an empty seat on a flight from of an out-of-the-way place can be a problem.
For more seriously injured vacationers on a trip abroad, getting home can be a costly process, but there are a growing number of insurance, referral and emergency services plans that can make the job cheaper and easier.
The Travelers Insurance Company last fall added emergency medical evacuation coverage to its trip cancellation coverage, claiming it was the first insurer to do so. Travelers will pay up to $25,000 to evacuate a customer "to the closest medical facility" where treatment can be obtained. That doesn't necessarily mean a flight back to the United States, though some other firms do guarantee a trip home. Check your insurance agent or a travel agent about coverage.
Three services which provided medical care to travelers have folded in the last year -- the result, industry sources say, of the unpredictably high cost of such operations.
Little more than a year after it was launched, a program known as Medical International was dropped by Credit Card Services of Alexandria, whose chief rival, SafeCard of Florida, also pulled out of the traveler's aid business. Both had promised to provide English-speaking doctors, transportation home and other medical services for an annual or per-trip fee.
Also no longer offered is a membership plan known as HOME (Help in Overseas Medical Emergencies) provided by a firm in Dallas called International Travelers Association, which still offers some other emergency services under the name Medix (800-527-0218).
International Underwriters Inc. of Falls Church, which specializes in insurance coverage for students studying overseas, in 1980 launched a service called Health Care Abroad for travelers, with fees starting at $1 a day and ranging up to $100 or so a year, depending on the price structure. HCA says it has a network of doctors and hospitals in 1,100 cities around the world. A phone call to a toll-free number directs HCA clients to the closest service facility.
Some other firms specialize in medical evacuation, but also provide referrals and other services to members who subscribe on an annual or per-trip basis. They include: NEAR Inc. of Oklahoma City (800-654-6400); Assist-Card of New York (800-221-4564) and International SOS of Philadelphia (800-523-4939).
NEAR's newest service provides pre-paid medical and hospital care in foreign hospitals for American travelers and in U.S. hospitals for visitors to this country, said founder Joseph Travis, one of the pioneers in the travelers' aid field.
While NEAR has operated as a membership organization until now, Travis said the company is beginning to arrange emergency evacuation and medical service for nonmembers on a cost-plus basis.
"I've probably had as many requests for evacuations from nonmembers as from members," said Travis. "You can't say no when someone calls and their husband or wife needs medical attention or they may die."
Travis says China is the most unhealthy country in the world for travelers, warning that as many as 80 percent of visitors there become ill because of poor sanitation.
The marketing pitch for such services dwells not on manageable injuries like mine, which are fairly frequent, but on the travelers' nightmares: unconscious in Kabul, blinded in Beirut, stranded in Surinam. In such cases, the high cost of medical care can justify the cost of the coverage. In actuality, insurance industry officials report, such services spend more money on direct mail marketing than they do providing medical service.
For cheaper referrals, pick up a copy of "Traveling Healthy" (Penguin Books, $7.95) a 560-page guide that not only lists doctors and hospitals in 23 countries, but evaluates the quality of medical care in various places and translates the names of U.S. prescription drugs into the local language.
To get off to a healthy start, the hospitals at Howard, George Washington and Georgetown universities provide immunizations and advice. The local medical schools also have specialists in exotic diseases in case you bring something strange home in you