Saturday, May 27, 2017

"first do not harm"...

...is the World Alliance for Patient Safety's goal. The alliance was launched in Washington D.C. in 2004 and the title leaves no questions regarding its purpose. According to my experience, it was about time.

byemyselftravels
Getting sick on a trip is hardly ever funny - but returning home in parts fortunately doesn't happen very often.
(Illustration: "#SCHWEIN1378" - by Swiss artist Andrea Staudacher)


For years and years that I've been travelling, I didn't even think about getting health insurance for my trips. Which doesn't mean that I never got sick. It's just that when I began to explore the world bye:myself, it was in Europe, where everything was covered by my regular German health insurance. When going to the US, I always stayed for roughly ten days only - and I know that this argument is completely illogical because it takes minutes to get sick and seconds to die. I mention latter because the travel health insurance doesn't only cover therapy and care, but also the cost for your body being sent back home in an appropriate container; hence I'd say this might be called the worst case scenario, and fortunately you won't use this service too often. So anyway, even though my chances to survive a ten days trip to the US weren't that bad, I could have always gotten sick. But I didn't.

While Euro-trips were covered and US-visits were short, medical service in every other country was very, very cheap and the insurance premium for a long term stay pretty high.
So no insurance, even when I began to travel with my baby at the age of two (just to be clear: I'm talking 'bout her age). And what can I say, the baby got sick from time to time. In Belize she got a sort of a rash. It's the tropics, it's hot and humid, perfect climate for a rash to stay.
At this point I might mention the fact that although you pay comparatively little for medical care, they are very, very generous when it comes to drugs: An itching mosquito bite? Go, cover yourself from head to toe with cortisone. A light flew? Here, have some antibiotics - or even better, pop two different types at the same time, just pop them like candy.
So the doctor at the hospital in Dangriga, without further ado or questions regarding allergies or intolerances, prescribed antibiotics. I wasn't very happy with the prescription, but I had two more months there and wanted the baby's skin to get better. So I took the prescription, put the baby back in the stroller and headed for the hospital's pharmacy.
It was a small window in a dark wooden wall. "Where is your bottle?", asked the lady in the window. I was confused - I had no bottle; and informed her thusly. She rolled her eyes. "How do you want to carry the medicine?" "In its pack?!", I answered reluctantly. "The medicine has no pack. You have to bring a bottle and we fill it up." Well, this to me was undoubtably a very new way of obtaining medication. Consequently I had - as mentioned before - no bottle on me. "Wait", the unsympathetic lady ordered. I heard her rummaging behind the dark wooden wall, and when she reappeared she had a bottle of "Newman's own ceasar dressing" filled halfway with some slimy, yellowish liquid. In addition to the cost for the medicine she charged ten cents for the recycled empty.
When I opened the bottle at home, a strong smell of caesar dressing filled the air. I hesitated a short moment. And then I flushed the content down the drain.
Back in Germany, I took the baby to the pediatrician, he put a tiny bit methyl violet on the affected area, and the rash was gone for good.

Unfortunately, Belize was not the only time that I threw out drugs some extremely generous doctors had prescribed. Avoiding the...let's call it 'unpretentious' public clinic in a small Honduran town called Trujillo, I took my three year old daughter, who seemed to have a bladder infection, to the private clinic. The friendly elderly doctor looked at her, frowned thoughtfully, took out a sheet of paper and wrote a long, long list. With this list he sent me to the pharmacy next door which - don't mistake coincidence for fate - belonged to his wife. I handed her a lot of money and she handed me a big shopping bag full of small bottles and boxes. At home I took a close look at the patient info leaflets - where there were any. While rummaging around I dropped and broke one of the bottles, so that problem was solved. And from the rest I more or less randomly picked one antibiotic and threw everything else out. The antibiotic did help, but no, this is not the procedure the doctor prescribes - and neither do I, but special situations sometimes require special measures.

It's terrible, but there are moments I do understand why Latin Americans call doctors 'matasanos' (freely translated: 'killing the healthy').

Anyway, years later I did get a travel health insurance for the first time. Only because the woman at the travel agency offered it when handing me our tickets to Hawaii. "It's only 19 Euro per year for the two of you. And getting sick in the US can get really expensive", she added, and I felt foolish to spend so much money on tickets and not invest another twenty bucks so I signed the contract. And guess what - two days before our flight home we went to the food court at a mall and my then teenage daughter Mimi had a burrito and threw up all night. The problem was that she didn't only throw up all night, she continued throwing up at the break of dawn, too, and went on all morning. She has an extremely sensitive stomach and once her guts get queasy she cannot stop. So after trying every home made cure like laying down to rest, moving around to get the circulation going, drinking some stale coke, eating a salty cracker, taking a shower and so on, I recognized the necessity to take her to the clinic. We hardly made it there since by then she was limp like a wet rag, holding a plastic bag to her face, her stomach contracting. "Hello, the doctor will be right with you. But first you have to sign here please", the friendly nurse pointed on the dotted line. "So the basic fee is 180 Dollars, everything else will be added to this." OK, 180 bucks plus maybe 30 or 40 for the saline solution - it's salty water in a plastic hose after all - how much can that be?
An infusion and three hours later I had my answer: 588 American dollars and 62 cents. The 180 bucks basic fee were probably for using their door handle; cash or credit?
Before forwarding  the invoice to the insurance company, I had a quick look at it: besides the basic fee covering...nothing, and a long list of services that I didn't understand, there was some medication they handed her although she didn't need them at all. We threw them out.

I don't know whether now, that we finally have insurance, she doesn't want it to go to waste, but since then she has been on many drip infusions in various countries for the same symptom - severe dehydration - conspicuously often. If all these hospitals around the world cooperated, we might get her a loyalty card.

byemyselftravels
Good morning, sunshine! Food poisoning made Mimi spending the night at the most expensive accommodation of our trip to Malaysia, thus not necessarily the most luxurious one.
(However, thanx again to the guys at Gleneagles Penang Medical Center, you did a good job) 

I harbor the suspicion that doctors are particularly bountiful when it comes to desperate travellers that will forward their invoice to insurances.
They not only lavishly prescribe drugs, they also tend to double check überthoroughly.

A friend of mine got an infection while she was in San Francisco. Her credit card was somehow limited and she still had weeks of travel ahead so although she did have travel health insurance, she went to a public clinic. Needless to say that this institution was in no way more glamorous than those in Belize and Honduras. She had to wait for hours and hours together with other not so blessed and wealthy people. Then she got an examination, a prescription, everything was fine. Weeks later she got a long invoice from the clinic stating besides the check up and the medicine also a - surprise! - pregnancy test. Nobody at this clinic ever asked her if she might be pregnant, informed her let alone asked permission to perform a pregnancy test. Plus they added more than 60 bucks to the invoice for it.
Having said that, the extra-info that weeks after going to a free clinic she found an invoice in her mail might make you reconsider. The clinics are free insofar that they look at you although you don't wave a credit card hello, but that doesn't mean that the consultation is actually free. And don't even think about not paying it because you think you're far away: if you don't settle the invoice within the time indicated, you'll have a bad credit entry in the United States.

Maybe now, after these anecdotes - and I spared you all the belly-aching-food-poisoning-hugging-the-bowl-stories, you might feel like having an apple; to keep the matasanos away.

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