Communication problems, dodgy facilities, massive medical bills – it can be scary getting sick overseas. Dr Jane Wilson-Howarth puts you at ease
Research the local health facilities at your destination before travelling; guidebooks will help. Check the Foreign and Commonwealth Office site (www.fco.gov.uk/travel); if the FCO says travel is ill-advised then it’s likely your insurance will be invalidated. Find out about international clinics; many capitals offer excellent choices.
Take a cash backup so you can pay up front for any medical treatment; cosseted as we are by the NHS, it’s easy to forget the bill.
Personally I rarely travel with hypodermic needles and syringes. If you need or want them, make sure they look like part of a proper medical kit and preferably carry a doctor’s note confirming what they are for. Do arm yourself with a list of any allergies you have, plus the generic names of any medications you might need to take regularly or often.
Make sure that your insurance covers everything you propose to do and declare any and all past medical problems.
Wherever you’re going, take a European Health Insurance Card (EHIC) – if you’re flying home and the flight crew think you’re dangerously ill they will divert to the nearest airport to offload you. If this is in Europe, an EHIC will ease the hassle and should save you money as no medical insurance policy will reimburse expenses that would have been covered by an EHIC.
It’s difficult to pick out particular countries as having the best or worst healthcare records – facilities vary within countries and unsatisfactory outcomes can occur anywhere, especially when a foreigner can’t communicate or doesn’t understand the system. That said, Central Asia seems to be the region where it is particularly difficult to find good healthcare.
The US State Department is critical of facilities in Egypt yet this is a country where hospitals have been set up for the wealthy and for foreign visitors, so experiences can be good. Similarly, while emergency services are at best patchy in Thailand, the best private hospitals in Bangkok are luxurious and pleasant environments to access treatment.
Many travellers and expatriates will choose treatment in an International SOS clinic (www.internationalsos.com), where standards of care are excellent, service speedy and English-speaking doctors on hand. Of course, these facilities come at some cost.
The Foreign Office was aware of 3,752 Brits being hospitalised abroad last year; this is an increase, despite the fact that traveller numbers are falling. Research your options before you travel and, if you can, ask locally which hospitals are the best. Your embassy can advise, as well as hotel staff, friends and guides – though locals may not direct you to the best facilities if they know them to be expensive; point out that you want the best, and that your insurance will pay.
Any decent travel insurance will offer a 24-hour helpline that will be able to advise on good and bad facilities. In addition, insurers often send out medics to bring people home.
A common misconception is that if everything goes wrong health-wise, you can just call an ambulance or your insurers and you’ll be helicoptered home. It isn’t usually that simple. If you are taken seriously ill and want or need to go home there can be constraints. For example, fractured limbs aren’t usually put in full plaster immediately and you shouldn’t rush medics to complete the plaster just to get home. Also, you may need to wait for a flight with appropriate medical staff.
Flying might even be dangerous. You may not be well enough to survive the reduced oxygen environment of an aircraft. Sitting on an aircraft can make a limb swell inside a cast and compromise the blood supply, and it is unwise to travel with a jaw wired, unless there is a means of cutting the wires in case of vomiting.
In the West we have moved away from the ‘parental’ model of healthcare: British doctors are trained to communicate and negotiate with patients, as well as consider each patient’s knowledge, ideas and cultural issues. However, foreign doctors may still use the old model. Be diplomatic when consulting; linguistic misunderstandings can make you or them seem rude when this wasn’t intended. Many doctors are used to being treated like gods and may resent you asking too many intelligent questions, or wishing to discuss treatment options.
Invasive procedures increase the risk of infection so try to resist medical staff putting up a ‘drip’ (intravenous saline) unless you are seriously dehydrated or have lost a lot of blood. If there’s a choice ask for treatments that can be administered by mouth rather than injection since this reduces the chance of a severe adverse reaction. Avoid combinations of treatments if possible – the more medicines you take, the greater the chance of harmful interactions. Ideally your doctor should make one diagnosis and give you one treatment to cure this – plus pain relief if needed.
Your best sources of help and information are via embassies and your insurer’s medical assistance agency. English is remarkably widely spoken amongst doctors throughout the world and at most destinations you should seek out an English-speaking practitioner. Regions where this is going to be challenging include those where education is primarily in – say – French (as in francophone Africa), Spanish (Latin America) or Portuguese (Brazil, Mozambique), and in Central and East Asia.
According to new research by the Foreign Office, two-thirds of people don’t know what they can and can’t do abroad. There is a long list of countries, for example, where driving with any alcohol in the bloodstream is illegal. Find out what is illegal at your destination – and at any stop-overs – and don’t break the law. Guidebooks generally contain good advice; there is also information at travel.state.gov/travel and fco.gov.uk/travel.
There were 5,700 arrests of British nationals overseas last year. Some travellers are surprised they’re answerable to local laws: you are, so act accordingly.
Dr Jane Wilson-Howarth’s Essential Guide to Travel Health (Cadogan) features all that a health-conscious traveller needs to know.