One morning during a family trip to Costa Rica last winter, I paddled out to catch some waves while my 8-year-old took a surfing lesson close to shore.
The swell looked bigger than it had the day before, when I’d enjoyed a fun session on a rented longboard at the same spot, near the small surf town of Nosara. With only a few days left before our flight home, I decided to brave the choppy conditions anyway.
Mistake. My timing was off. On my first attempt of the day, I fell off the face of the wave into the churning rubble underneath.
When I finally surfaced, blood was flying. It continued to gush from my nose as I paddled frantically back to the beach, where a surfing instructor rushed me into his car and headed to the local clinic. I looked as if I had come from a crime scene. The receptionist took one look at me and said, “Surfando?”
Many of the millions of people who take international trips each year end up getting sick or injured, says Davidson Hamer, a global health expert at Boston University. In a recent survey of about 600 Boston-area travelers, he and colleagues found that health problems forced 25 percent to cancel or change travel plans. Seven percent reported visiting a clinic while traveling. One percent ended up in the hospital with serious medical problems.
Diarrhea and gastrointestinal issues are the most common causes of medical distress on the road, according to a 2013 study of data on more than 141,000 mostly American travelers. Using a database maintained by the Centers for Disease Control and Prevention, the study found that 8 percent reported getting sick enough to seek care while traveling or soon after they got home.
The doctor I saw in Nosara told me he treats enough surfing injuries each week that he has chosen to avoid the sport altogether.
“It’s relatively rare for a real catastrophe to happen that requires evacuation,” Hamer says. But accidents do occur, and people often fail to prepare for them, he adds. “I think the best we can do is try to get people to think more about this in advance.”
While it is impossible to predict everything that might happen, there are ways to reduce risks, says Albert Wu, an attending physician at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
He suggests investigating the hazards specific to your destination, including infectious diseases such as malaria and Zika. Travel information is available via websites of the CDC and the State Department, among other places. Some vaccines take a while to kick in, so start planning early.
“Wherever you are, you would ideally like to have a rough plan so that if there were some catastrophe, you wouldn’t be completely without access to any health care,” says Wu, who once treated his own injuries after landing a rented motorbike in a ditch on the Greek island of Santorini. “You should try to be pessimistic for a minute and think about what could go wrong and if you would be okay with that.”
Pre-trip research should also include some thought about how you’d pay for any care you may need. Many U.S. health insurance plans will reimburse medical bills acquired during travel, so be sure to check that your plan is among them. Some credit cards, employers, tour companies and membership organizations such as AAA and AARP also offer travel benefits including 24-hour medical-referral advice and discounts on supplemental travel insurance.
Supplemental policies can fill in the holes, says Tullia Marcolongo, executive director of the International Association of Medical Assistance to Travellers, a nonprofit that maintains a network of multilingual medical providers.
Among its services, IAMAT offers a guide to navigate the crowded marketplace of insurance options. Those policies can be confusing and often contain fine-print exemptions that might leave you uncovered or unreimbursed.
Before you buy any supplemental health coverage for a trip, verify that the insurer is licensed where you live so you can take legal action if your claim is denied. IAMAT also recommends investigating the company’s track record with consumer protection organizations and online forums to make sure that it really provides the services you think you’re paying for.
If calamity strikes, you can usually call your own doctor back home for advice, Wu says. U.S. embassies and consulates can also provide information and connect you with English-speaking doctors.
Hamer suggests searching in advance for a clinic that has been vetted and certified by the International Society for Travel Medicine or the American Society of Tropical Medicine and Hygiene. He also recommends enrolling in a service such as International SOS, which provides information and referrals in more than 200 countries. Prices vary; as an example, coverage for a week-long trip to Costa Rica would cost me about $100.
Easy access to reliable advice would have been welcome after I got hurt in Costa Rica. The clinic I was driven to didn’t have an X-ray machine. So after I got a shot of morphine there and a change of clothes, my husband loaded me and the kids into our rental car and drove for two hours over bumpy, rutted roads to the nearest hospital with an ear, nose and throat specialist. My nose was broken, the doctor told me in Spanish — a language in which I am proficient but not fluent. He would put me under general anesthesia the next day to fix it.
Since it was after hours, we were unable to reach my primary-care doctor or a specialist back home, but with emergency surgery in a foreign country suddenly on the table, we started communicating with physician friends in the United States, who suggested that I wait a week for the swelling to go down. That was exactly opposite of what the Costa Rican doctor had recommended.
My final decision emerged after a moment of serendipity: At a restaurant near the hospital where we had stopped for some food, we overheard the word “nurse” wafting out from a conversation at another table. It turned out the table was full of Costa Rican and American medical professionals who already had heard about my case. After talking with colleagues, they agreed that I should wait. With Advil to stave off the pain, I flew home as scheduled a few days later, with a broken nose and a story to tell.
I’m not the only one. In an informal survey of friends, I discovered a remarkable collection of tales that included bites from monkeys, rats and dogs in Indonesia, Sri Lanka, Thailand and Ecuador. Most were treated locally and all required rabies shots.
One friend discovered she was allergic to mangoes when she broke out in hives in Tanzania. Local doctors had thought she had malaria. Another one developed appendicitis on a ship in international waters and had to be rescued by a Coast Guard vessel that raced her to Nova Scotia for emergency surgery.
That broken nose is not my only tale of hazardous travel. I was once stung by killer bees during an expedition in the Peruvian Amazon and took antihistamines while bracing for an allergic reaction that, thankfully, never came. That happened after another person on the trip had stepped on a venomous stingray. I watched helplessly as local guides dipped his swollen toe in scorching water steeped with a medicinal jungle plant.
Life is an adventure. Before my next trip, I’ll try harder to expect the unexpected as soon as I walk out the door.