Before you go on vacation, take a trip to the doctor
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Borneo or Miami's Mount Sinai Hospital? An unfortunate choice -- but an easy decision.
So instead of spending a recent Monday morning as I'd planned, stuffing my suitcase with zip-off hiking pants and leech socks, I snoozed restlessly on a sofa in Mount Sinai's Abess Waiting Room. Soon, a surgeon I'd never met -- The Husband had made the choice -- would deliver the news that would determine much about our future.
The Husband's heart murmur had been discovered a few weeks before in an annual physical by the family doctor he's seen for 25 years. He'd experienced no symptoms except chest congestion that we'd written off as asthma. His weight was trim, cholesterol down, fitness level up. We had no way of knowing that his mitral valve was trashed.
As a veteran traveler to places far and wide, I can easily imagine the outcome if his condition had gone undiagnosed. Instead of fidgeting in the relative comfort of a Miami hospital with top-notch medical care, I might have been dealing with a disaster in the jungle, days from any modern facilities -- and alone.
It happens. Cardiovascular issues are the No. 1 cause of death for Americans abroad, accounting for 50 percent of the 5,000 to 6,000 fatalities annually, says Dr. Brian Terry of the Healthy Traveler Clinic in Los Angeles, quoting the Journal of Travel Medicine. (Traffic accidents, drowning and homicide -- all often mixed with alcohol -- also rank high.)
Some of the lessons here are purely medical: Develop a relationship with a family doctor, and see him or her annually. If you do need serious care and you have the luxury of time, do your research. (The Husband interviewed three surgeons before choosing his.)
Other tips are especially important for travelers. They come from our own experience and that of experts.
GENERAL TRAVEL
• Consider medical evacuation insurance; paying for an evacuation on your own can cost as much as $100,000. Single-trip travel insurance policies typically include evacuation and some medical care, plus protection against delays and lost luggage. (See www.insuremytrip.com, www.quotewright.com and www.squaremouth.com.) Note that your regular health insurance may not cover you abroad; check it out in advance.
If you're a frequent traveler, consider an annual medical evacuation policy like the one from Medjet Assistance (www.medjetassistance.com). This will get you to a hospital at home in case of a serious illness. (With all policies, read the fine print carefully.)
• Bring all prescription medications -- plus a few days of extra supplies. Snowstorms happen.
• Use safe sex practices. Terry tells the story of a rocket scientist -- no kidding -- on an extended assignment in Africa who contracted an STD from unprotected sex.
• Use seat belts and appropriate child car seats, and buckle up even in taxis. Car accidents are the No. 1 fatal injury for Americans abroad.
• If you have an unstable medical condition or have recently had surgery or other serious treatments, consult your doctor before you travel. Carry copies of your medical records and doctors' contact information, and be sure your companions know where to find them.
ADVENTURE TRIPS
• Before you head out on an adventure that is physically demanding or takes you to remote places, get a physical exam.
• Get in shape before you attempt physical challenges -- and be sure you've got the right gear. On my first adventure trip, I trekked through the Thai jungle in cheap sneakers, ending up with aching feet and leeches (from slipping into a rice paddy).
• Find the name of the best regional medical facilities before you head to a remote destination. Check the U.S. State Department Web site ( //travel.state.gov) for embassy contact information in the country you're visiting; most U.S. embassies have a medical officer. (You may want to consider registering with the embassy before you visit; the Web site offers instructions.)
• Check out safety conditions in your destination at the State Department site, www.smartraveller.gov.au (the Australian government), www.voyage.gc.ca (the Canadian government), and/or www.fco.gov.uk (the British government).
• In developing nations, avoid foods that aren't cooked or that you can't peel. A single sliver of lettuce dropped me for 48 hours in Mongolia.
• Be sure you're up-to-date on inoculations recommended for your destination. The Centers for Disease Control's Web site, www.cdc.gov, can help you figure out what you need, but an experienced travel doctor is better. Terry says he often sees patients who have misread the CDC recommendations or are relying on advice from neighbors.
You can find travel specialists through the International Society of Travel Medicine's Web site, www.istm.org. South Florida has more than a dozen members from Homestead to Boca Raton.
• Carry first aid supplies -- and not just Band-Aids. (The Husband once got an infected leg on a remote island; we had to fly nine hours to get antibiotics.) Ask travel medical experts what you need. For example, the Masta Clinic in London (www.masta-travel-health.com), which advises many Third World travelers, suggests taking clean syringes to Cameroon, where sterile supplies can be in short supply.
• If you get sick and need a doctor, ask your hotel desk for help. You'll probably pay less and get quicker service during daylight hours -- and visiting an unfamiliar hospital after dark is downright scary.
If you're traveling alone, ask a fellow English-speaking traveler to be present. When I got sick in Vietnam, an Australian couple I'd met on a day tour offered to stick with me while the doctor visited. That alone made me feel better.
• Acclimate before attempting high-altitude adventures -- especially if you're a flatlander. A few years ago we flew from Miami to Bangkok -- also at sea level -- then immediately to 6,000 feet for a multi-day hike in the Himalayas. We were so wiped out we didn't enjoy the trip.
• Hydrate or die. That Scouting motto isn't a joke. I nearly collapsed from dehydration in Nepal because I didn't want to have to pee in the woods. Now I know that any bush will do. (And beware: You can get overheated in a city; it's happened to me twice in Beijing.)
• If you feel uncomfortable about a physical adventure, bow out. After being tossed out of my raft twice in Class 5 rapids on the Zambezi River, I insisted on riding in the safety dory. Turns out my position on the raft was known as the "ejector seat."
At an earlier age I would have been too embarrassed to quit; now I realize that saving face isn't worth drowning.
• Get your will, medical powers of attorney and other paperwork in order, and have them readily available for faxing should you need them.
It sounds grim, and like most people, we put it off. We finally signed them the day we left for Cameroon, which seemed remote enough to warrant extreme precautions -- and was. When this recent crisis erupted, we were glad we'd taken care of the legal matters without the added stress of a medical emergency.
In our case, all's well that ends well. The Husband is home, and we're planning our Next Big Adventure.
Borneo is still on the list. Or maybe we'll opt for Ethiopia, San Francisco, Europe or some place close to home. This year, there are plenty of bargains.
For us, travel -- and life -- are still a trip.
First Published January 31, 2009 12:00 am
