TRAVELIN' TROTS: Diary of an Accidental Medical Tourist
by
Mary Anne Lonze
SMASHWORDS EDITION
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PUBLISHED BY:
Travelonz on Smashwords
Travelin' Trots: Diary of an Accidental Medical Tourist
Copyright © 2010 by Mary Anne Lonze
Smashwords Edition, License Notes
Thank you for downloading this free ebook. You are welcome to share it with your friends. This book may be reproduced, copied and distributed for non-commercial purposes, provided the book remains in its complete original form. If you enjoyed this book, please return to Smashwords.com to discover other works by this author. Thank you for your support.
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There are a few people I'd like to thank.
Tom, for your love and support. Every day with you is a delight. The folks at the Radisson Plaza Indepencia who provide terrific service. The people in Panama, even though I can't go back there again.
And you, my reader, for letting these words into your life. I hope you will be entertained and enlightened. It's the best we can do for each other.
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TRAVELIN’ TROTS: Diary of an Accidental Medical Tourist
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CHAPTER ONE - I'm Still Here
Montevideo, 2010
Now, this isn’t the trip I’d planned. I’m at the Radisson in Montevideo. I’m sicker than I can ever remember. So I lie in the semi-darkness day after day staring at the tiny red lights of the hotel room smoke detector winking at me from its ceiling mount.
My body is soaked with sweat; sticky and smelling like a dowager’s drawers. Alternately, I turn paper dry, racked with chills. Worst of all, my world is limited to the few steps on the path from bedroom to bath. I’ve made so many trips there over the last 72 hours I’ve lost somewhere between 15 and 25 pounds.
If a gallon of plain water weighs 8.35 pounds, this could mean as much as 3 gallons of fluid has migrated from my colon into the local plumbing.
But there’s really no way to get an accurate reading since the bathroom scale, dating back to the early 1960s, fluctuates wildly depending on where I stand on it’s peeling surface.
I wasn’t always filled with such pessimism, but could that be The Grim Reaper lurking in the shadows? Well, it’s my own fault. If I hadn’t been so hell bent on writing a medical tourism article, I could instead be gazing at a golden sunset from the terrace of a Venice, Florida, hotel. But I insisted on a week’s layover in Panama City. And it walloped me good.
Look, I’m a nurse as well as semi-seasoned traveler. Careful to the point of near-fastidious behavior, I follow all the rules about what-not-to-eat-or-drink when I’m on the road. So it didn’t make sense to me that I got so sick. Besides, I shared every sip and forkful with my faithful, fearless and loving travel companion, Tom. And he remains (irritatingly) healthy. But it happened anyway.
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CHAPTER TWO - Where It Began
Two hours into the 7-hour-long (underscore “long”) flight from Panama City to Montevideo, Uruguay, I felt a stabbing pain in my right wrist. An unnatural-feeling sentinel event.
Growing increasingly chill as the flight droned on, I wrapped myself in the thinly woven, blue-grey airline blanket. A paper-wrapped micro pillow kept slipping between my aching head and the window. Each time my head hit the pane; it felt as though a masticating juicer was crushing its contents. Even under the best of circumstances I often find it impossible to get comfortable on a long flight.
The plane bucked and yawed over the Andes for nearly an hour. At several points I had to clutch the back of the seat in front of me just to remain in mine. The relentless lurching of the aircraft matched that in my stomach.
On and on we traveled into the night, through 3 more time zones. By 10:15 local time we landed at Montevideo’s Carrasco airport with it’s swanky new terminal. Wandering through the maze of duty free shops we finally arrived at immigration.
Through a feverish haze, I straightened up and quickened my pace to appear altogether pleasant and alert lest I be turned back at the gate like a consumptive émigré at Ellis Island, circa 1907. I had made it.
Outside, the hotel shuttle we’d arranged for was nowhere to be seen, so we hailed a cramped taxi with a leaky exhaust pipe – the odor of which was only slightly overpowered by the driver’s pungent aftershave. Then through a pounding summer storm, we sped through the darkness on the Rambla Sur, the windshield wipers smearing a greasy rain.
An hour later, we arrived at the Radisson hotel flanking the Plaza Indepencia on the edge of the ciudad vieja. Like the Overlook Hotel from “The Shining”, this one was frozen in time. A glitzy 3-story glass and marble lobby opened out into the cool, ornate lounge cum piano bar.
But stepping off through the polished brass elevator doors onto the upper floors, the air in the corridor was heavy and still, as though it hadn’t been refreshed in decades. The room furnishings seemed to be taken from an old Sears catalogue. But I was too ill to care, and crawled into bed, ignoring the welcome basket and skipping a shower.
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CHAPTER THREE - Days Of Malaise
Awake the next morning I realize the room temperature always fluctuates between not quite warm enough, then too warm. Cool, smelly air blows from the air conditioning vent mounted near the top of the wall. No matter where I lie on the bed, I am in the glide path of the fins that direct a stream of cold dusty air onto my hard, lumpy pillow. The dryness causes a catch in my throat when I try to speak which makes me cough.
Every few hours I fish out an old-fashioned mercury thermometer standing in a glass of melted ice. It’s sitting on a marble-topped nightstand that has a deeply carved wooden base. Though small, the piece is too heavy to be moved without the assistance of a forklift.
My fever ranges between 37 and 38.8 degrees Celsius. This is too high, but I’m too weak to crawl to my laptop in the next room to click on its temperature conversion app.
On the other side of the tightly closed drapes, dawn gently lights the city. Across the street on the rooftop of a nearby chapel, a little cluster of hung-over revelers hug sleeping bags while listening to a balladeer stroke his 6-string guitar. Countless empty beer bottles and a thermos or two of mate (an herbal beverage) shine in the morning sun. If the window could open I’m sure we could hear an enchanting folk ballad. Or maybe the refrain of a drinking song chanted after last night’s parade.
19 floors below and a few blocks away, a cruise ship pulls into the dock. It will soon disgorge a handful of tourists to wander a small corner of the old city, look for an English newspaper then become indignant when the shopkeeper won’t accept a dollar bill. After a few hours, they will climb back into their cozy berths satisfied to have “done” Uruguay. This brief airing out of floating tourists will be repeated hundreds of times each year like an endless da capo repeat.
The more adventurous will find a city with beautiful colonial architecture lavishly strung with wrought iron-fronted balconies; city parks hosting craft markets and the barbeque restaurants of the El Mercado del Puerto, costing a fraction of what you pay at similar sites across the river in Buenos Aires.
Or the Rambla Sur running like a seam between the endless sandy beaches and multi-storied modern apartment buildings and condos. They might even stumble across the big shopping center, or El Cementerio and wander through the cluttered necropolis to see the elaborate gravestones and monuments created by world famous 19th century sculptors.
Ah Montevideo, so beautiful in the summer - which is the only time I’ve ever been there. It’s a stark contrast to the bleak Chicago winter we’d left just a few days before. This city of 21,000 platano trees, evening parades and bife de chorizo blooms with outdoor life. Like going to a lovely old-world European city, but with friendlier people, it remains one of my favorite cities to walk.
But for now I’m not going anywhere, being so sick and sick of being so. Haven’t eaten in days, and haven’t missed eating. Bucket after bucket of ice water is all I can hold. My insides are so empty they must echo. Every strand of hair, every inch of skin aches. If my fingernails could scream in pain, they would.
I have become the medical tourist that I planned to write about. Thinking it will either kill or cure me (and I have no particular preference at this point), I agree to bring in a local doctor.
Within a half hour of contacting the concierge for medical assistance, I hear a knock on the suite door. The desk clerk enters. Behind her a young woman with delicate features and curly dark auburn hair pulled into a ponytail. She wears a white tunic over white slacks. It’s similar to a uniform I wore in nursing school years ago. It even has embroidered identification patches on the sleeve. A bulky man follows, carrying a bulky blue plastic container the size of a picnic cooler. He starts to unpack it at the bedside.
The woman-in-white is asking questions, taking a historia clinica. She speaks no English. I don’t speak Spanish. I remember joking with our Columbian flight crew on the Houston-to-Panama leg of the journey.
"I only know 3 words in Spanish – “ceviche, cerveza and banos,” sez I, in good humor.
"That will cover all your needs," replies them.
Now, I am wishing I’d taken a closer look at Rosetta Stone before leaving home.
The desk clerk begins to translate as a thermometer is slipped into my armpit. A few moments later I read the alarm on the practitioner’s face as she states my fiebre is too high. I don’t need a translator for that.
Quietly she gives a directive to the bulky man who begins wrapping a rubber tourniquet around my upper arm. The clerk smiles “you need an IV”.
Before I can spit out the next question, he has me swabbed and injected just above the wrist. It hurts. My nursing experience – and a touch of paranoia - kicks into high gear, fear running rampant. I am convinced he is using a rusty needle infected with HIV and curare. Too late. He’s finished and has already packed up the used syringe and rubber hosing.
The doctor writes out a prescription and presents the documents for signature. They leave.
More buckets of ice are brought in. I am too tired to do more than drink a few sips, poop, and then return to bed. I have become a bambino, but I’m too big to be cute.
The drapes are re-closed, lights turned off and I fall asleep to the rattle of the air conditioner, trying to piece together what the heck happened to me in Panama.
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CHAPTER FOUR - EEN Pana-ma
It was an ordinary Friday morning at the Sheraton hotel, the seventh day after we landed in Panama City. I was soaking in the oversized Jacuzzi-style tub watching the golden sunrise over the ocean and hoping to catch a glimpse of the cargo ships lined up waiting their turn to cross the Canal.
The first time we came to Panama in November 2005, we had stayed in the very same hotel. Only that time, guests could look out the window and see a whole string of ocean-going ships day and night. Five years later, several new condo buildings obstructed that view. Now you can only see the building windows, and wonder what grand sights they have.
I dressed in the only business casual outfit I brought along. After slicking my fuzzy grey hair down with a load of Keratase crème, I began to browse the Internet over several cups of procrastination. Finally, I velcroed my sandals, strapped on a small camera and grabbed the leather binder I’d previously loaded with pens, business cards and a stack of notes. It was time to begin research for the medical tourism article, the cornerstone of this trip.
Down in the lobby a handful of suited men on cell phones were arranging their day or plotting the takeover of the universe, I couldn’t tell for sure. This is a very businessman-oriented city. Just beyond the front glass doors, taxis were beginning to queue up, looking for lunchtime fares. Traveling alone on this part of the project, I chose an SUV driven by a uniformed driver who spoke fluent English.
Jean Pierre, my driver, was a pleasant young man who chatted freely about the city and its people, as he navigated the van through the endless traffic jam. At first I was coy about my mission, but he was so charming I eventually laid out my mission. Off we went. JP drove across town filling in the blanks with his stories and observations.
He was proud of Panama’s relatively new 911 emergency service – just 1 year old. Prior to that program a patient had to find his own way to the hospital, and many people died waiting for a private ambulance. There are now twenty-seven “911” ambulances in that program, and many more private ones scattered throughout the city. “There are even 2 ambulances waiting in front of the Sheraton,” he pointed out. Each hospital has 2-4 private ambulances as well. A doctor rides in the hospital’s ambulance. That surprised me - doctor riding in an ambulance.
“If you need emergency services,” he continued in very good English “you can be treated at any ER, but will later be transferred to the appropriate hospital”.
That means no matter what kind of coverage you have, if you look like a wealthy Panamanian, you will be sent to a private hospital for care.
“That’s what happened to me after my car accident” he said, “because my skin is light and my eyes are blue”.
Every state in the country has a hospital in its capital city; but if you get really sick you may need to be airlifted to Panama City. In the smaller towns like Boquete there is a clinic, but not a hospital. Patients may have to travel to the city of David if they need more intensive service. JP explained it’s because of the terrain.
Panama is a rainforest dotted with a few – very few – towns. There are some along the coastline and a handful in the interior, populated by locals and expat retirees. Panama City and Colon are the largest cities, one on each end of the canal. Travelers can take a boat an ageing railroad or drive along a 2-lane road from one end of the canal to the other (actually all are very cool ways to get there). Connecting some of the other towns and villages are a handful of roads. In between there’s little else but trees and lots of bugs. So the fastest means of transport is by small plane.
As we bumped and lurched through the traffic-choked streets, he began to explain their 3-tiered medical system. The lowest cost program is the public. A flat fee of $30 – 60 per year covers all services. For other patients an x-ray may only cost $1.00 and a doctor visit 50-cents.
If a patient gets admitted to a hospital he arranges for his own follow-up care. There is no extra charge if you’re using the public program, but the doctors will rush you in and out of the office since there’s no money in seeing a patient in the outpatient setting. But if you have private insurance the doctors will take their time since you will be billed for it. The “social” program benefits fall somewhere in the middle.
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CHAPTER FIVE - The Whiz-Bang Hospital
Our first stop was the whiz-bang Hospital Punta Pacifica, a facility as high tech as any I’d seen in the states. Even their website is a knockout. http://www.hospitalpuntapacifica.com
I was hoping to wander through the halls unannounced, to get an idea of what the facility felt like to the casual visitor. Maybe even get an audience with an administrator. But there was no way we were going to get through security without good cause. And the receptionist in the shining antiseptic lobby wasn’t buying my story of being a travel writer doing a story on medical tourism.
This was no offshore, flea market stall medicine hut. An affiliate of the Johns Hopkins medical system, it is the destination surgery vacations. They actively solicit medical tourism as part of their business model and is at the forefront of what is becoming a modern international health care delivery system of the future. Even though a wide range of services is offered at a price range between 50% and 80% lower than what a patient could find in the U.S., the facility is equipped with state-of-the-art technology and a bi-lingual medical staff.
Patients pick a doctor, a hospital (doctors can work in any hospital countrywide according to Panamanian law) and a recovery hotel or spa. They get a quote on the cost of services from the facility, and can even get the doctor’s email before leaving home. There is lots of personalized service on arrival. Pack your wallet and off you go.
Who wouldn’t want to recover from a medical procedure in paradise, just 2-1/2 hours flight time from Miami? The climate is tropical - averaging 80-degrees F. during the day, with cool evenings. International cable service, satellite and Internet are widely available. Cell phones work. Nearly everyone speaks English, the official currency is the US dollar and you can even drink the water.
But like the 2 classes of local taxis – expensive SUVs with uniformed drivers versus cramped yellow cabs driven by non-English speaking locals, there is more than one class of medical services. You need to do your homework before setting off.
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CHAPTER SIX - Serving The Masses
We left the top-notch facility and drove across town to the public hospital, Santo Tomas, where thousands of patients are seen every year. This 300-year old facility is one of the biggest teaching hospitals in the country with a level 1 trauma center and 632 beds.
Jean Pierre said the attention is pretty good, but because of the high volume of patients, you may have to wait a long time for service. Here the families of the sick are housed for free on the hospital grounds because of the distance some have traveled, and their inability to pay for lodging elsewhere. You could see lines of people everywhere.
The facility is near the red light district. Across the street from the main hospital was a row of noisy street vendors. It’s 3 main facility buildings, parking garage and gardens looked worn. Some of the exterior walls were stained and peeling.
I doubt that fussy international tourists would knowingly pick this place for medical services. It’s on the lowest rung of the 3-tiered medical system, and I began to wonder if some of the amazingly low costs for service touted in some of the medical tourism articles I’d researched had factored in rates from this level.
One reason the rates are significantly lower than in the states may be the local doctor and nurse salaries. They are appallingly low – to the point where no one would even answer the question directly, when asked. That’s why Panama is losing lots of nurses to the US, because of salary differences.
Another is the requirement that newly minted doctors must put in at least 2 years of public service before they are licensed (nurses have a 1 year service requirement). Also doctors’ service hours are regulated by the state. So maybe it’s not so good for practitioners if healthcare is government run after all.
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CHAPTER SEVEN - Still Feelin' Poorly
Waking up, I realize it’s now eight hours since the burly man administered the injection and this patient is showing no signs of improvement. I’ve lost count of the number of trips to the marble lined bathroom. My bowels are churning out glistening green fluid. A hot stabbing pain still courses behind my eyes. As I lay in the quiet, darkened room both phono- and photophobic, I begin to understand how people can perish from dysentery. I am feeling very sorry for myself indeed.
Dear imaginary food diary: today I am having 2 tablespoons of rice.
Tomorrow I will have 2 tablespoons of rice and half of banana.
Maybe.
On the third day after arriving in Montevideo, I am still sick but gather the strength to bathe. I cannot bend over to adjust the bathtub drain stopper without a stinging rush of headache. Surely I must be having an aneurysm! Unsteady on my feet, I require assistance in and out of the tub.
I am so blessed that my Tom is there to help. With the instinct of a true hunter-gatherer, he goes out to the farmacia to get every prescription filled or find what little food I am able to tolerate ... and generally listen to my bitching and moaning ... with all the kindness, patience in the world.
I am ready for a colonoscopy. There is nothing left inside my gut and I can feel my ribs – first time in years.
Certain that my electrolytes are so out of balance they are off the scale; I begin to self-medicate with an over-the-counter powder. It is disgusting. Diluting it in a thick orange-colored soup destroys the taste of the soup itself, and then brings on stomach cramps. I search for a counter-remedy to the remedy and start popping Pepto-Bismol tablets, which brings on another bout of emerald green diarrhea. Nothing stays in my colon long enough for the bile to break down.
The fever persists, stubborn as a grape stain.
A second doctor arrives. Her writing is microscopic, but she speaks fairly good English.
“Everything is normal. She is in good health,” says the middle-aged doctor with short brown hair and a reassuring tone.
“Huh?”
No medications are substituted, added or discontinued. I am living on Fadal and Dolex (there are no words for these in English). I remain unconvinced and wonder, “How is this helping?”
Yet a few hours later I am able to migrate to the adjoining sitting room. Tucking myself into the corner of the blue floral sofa, I snuggle into the pillow and scratchy blanket that I manage to drag off the bed. Just listening to the vintage Goldstar television on the built-in shelf of the opposite wall saps my remaining strength. It broadcasts only a handful of Spanish channels, but after the sun sets some are subtitled in English.
My eyes cannot focus at that distance, even with glasses. So I spend a good deal of time staring at the plant in a massive ceramic pot on the floor. It’s tired stalks of leaves heavily bent from the long-term effects of phototropism.
Endless chains of buckets filled with ice get delivered day and night. It melts quickly in the summer air. There are no straws. I shovel out chunks of ice with the demitasse spoon saved from the breakfast coffee service. We are practically on a first-name basis with the room service staff.
In the morning, housekeeping knocks on the door. A woman of German decent with kind eyes enters, and checks my progress. By now my fame/predicament is known throughout the hotel. She inquires after my health in Spanish. I respond in English. Neither one of us understands the other. Through gestures and facial expressions we exchange info bits. She peers at my medications lined up on the heavy coffee table and nods in satisfaction, then returns to her chores.
Later, after stripping the bed, she brings me an extra blanket, and a fresh sheet to soften the feel of the rough blanket. She smiles reassuringly as she tucks me in under a fresh sheet.
I miss my mom.
Too weak to type, I resume writing the medical tourism article in my head.
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CHAPTER EIGHT - The Mid-Range Health Facility
JP and I continued on to the Hospital Nacional in Panama City. He was eager to continue in his role as host and translator. He knows the security guard there, and can get us in.
While he parked the van, I strolled into the flower-filled lobby of this private facility. It looked like a boutique hotel with 81 beds. 35 years ago a doctor founded it as an obstetric facility. His family still runs it and to this day they still deliver over 2,000 babies per year. Most recently they’ve expanded their services to include diagnostics and joint replacement surgery.
After a few minutes, one of the administrators agreed to meet us and hosted a grand tour.
As we walked the corridors, he began by stating his hospital is not actively seeking medical tourists.
Although the hospital provides services for some foreign patients, these folks are employees working in Panama City, military retirees, international office staff or some visitors who happen to get sick and find their way in.
That’s one of the problems with statistics quoted by medical tourism advocates. Everyone counts it differently.
I asked him about a local article that listed this hospital as a medical tourism destination.
“That article is deceiving” he replied, “Most medical tourists do not go here for treatment.”
He went on to say that one of the biggest obstacles facing medical tourists is the problem with continuity of care. Another one is insurance. Although they do work with international insurance companies, all payments are cash up front and some insurance companies have been known to not reimburse patients. Denials and appeals can be tricky and patients should have a clear understanding of how international coverage and billing actually work. For example, do they have a direct billing association with the facility?
I learned that most of the doctors and nurses are bilingual, but other staff – including housekeeping, are not. So if the patient wakes up in pain or parched, they might run into unexpected roadblocks getting a simple glass of water or an extra pillow.
The hospital has about 400 employees in total, but it’s hard to say what the nurse-to-patient ratio is due to service provider’s overlap. Who is considered a registered nurse? A student nurse? A nursing assistant?
There are 150 physicians who work from there, but no house staff. They are all independent contractors who work from any hospital in the city.
Walking down the hall, we toured an empty patient room that looked efficient, yet Spartan despite the flat screen TV hanging on the wall. Each bed had an accompanying night table and a plain vinyl chair for visitors. There was only one small bathroom.
Hospital Nacional isn’t accredited by the Joint Commission International, or affiliated with any US hospital – by choice, due to the costs involved. But they did have a nice coffee shop in the lobby.
In the maternity section I saw tall, basketed flower arrangements standing outside patient rooms. When I asked about that our host responded they “couldn’t allow flowers inside because of the risk of allergies and bug bites”.
This is Panama after all, where tens of thousands had died of yellow fever and malaria during the construction of the famous railway and the Canal. Made me itch just to think of it.
It was a clean, nicely appointed facility that is expanding to provide open-heart surgery, kidney transplants and diagnostic services. They have a spiffy website, but it’s in Spanish. When you click on the “English” tab, nothing happens.
As we drove back to the hotel, I was feeling lucky to be in good health. Luckier still I didn’t have to be looking for health care at the time.
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CHAPTER NINE - Riding The Couch
But five days after landing in Montevideo I’m still riding the couch. With a lot of help from Tom, I pull together the nits and gnats of my medical history to pass along to the third doctor.
Through an interpreter (we’re back to this again), I tell him that I am a registered nurse (enfermera titulada).
From his deep frown lines I see that he does not approve of my self-medication with the Augmentin 875 mg., which I found buried in my suitcase. My just-in-case stash.
Our desk clerk translates “it is not for the good germs.”
I pause to decipher what the heck she is saying, then it hits me, “it kills the good bacteria in the gut.”
"Si!" I sigh.
Like the previous 2 doctors, this surly fellow gives me a thorough examination, including a check of my sclera looking for signs of jaundice.
My symptoms have not abated, and because of their duration, he writes a script for Cipro. This I understand. “You will get better” comes the translation.
I ask about the rapid and significant weight loss over the past few days. “Don’t worry, you will gain it all back” he frowns.
"Drat!"
For 3 days I take the Cipro tablets twice a day, every 12 hours. These are washed down with glass after glass of apple flavored Gatorade – I have had enough ice water to float a cruise ship. I can’t even look at an empty glass without gurgling.
Cipro has odd side affects. This antibiotic makes things taste and smell different. It causes my mind to do odd things. I find that I am unable to type, write or count while on this medication.
While these are not the common side effects, I remember having the same bizarre side effects last time I took it. Like putting Windex in the freezer or letting the dog out … then forgetting I even had a dog.
The strangest are the Cipro dreams: wild, frenetic, complex and intense. Definitely entertaining, but I awaken feeling exhausted.
After the third day, these pills are discontinued, but it takes a couple of days for my system to settle down.
Another medication, Pimperam, is to be taken a half-hour before lunch and dinner to prevent nausea and vomiting. I take 3 doses and then look up the side effects on my laptop. I decide that my Americano stomach should not be taking this medication, and discontinue it.
The Fadal isn’t having much effect so I switch to Pepto-Bismol. Still, my poop is the color and consistency of macerated spinach boiled in its own juice.
During my countless excursions to the toilet, I notice the bathroom is nicely appointed with marble walls and floor. There is a large, well-lit mirror with ample counter space surrounding the single basin sink.
Usually it’s because men, who just don’t understand a woman’s need for lots of counter space to put out girl-stuff, don't design most hotel bathrooms well at all.
On the other side of a carved wooden door is a bidet next to the toilet. Beyond that a deep soaking tub. Curiously, the lever to flush the toilet is actually a metal bracket mounted in the wall. This is a problem. The headboard of the bed is mounted on the other side of the hollow wall. No matter how quietly I tiptoe into the bathroom, the sound of the flushing toilet blasts into the bedroom, awakening the soundest sleeper, and most likely the whole floor as well.
When I am able to eat I think about the list of probable (contaminated) suspects I might have ingested in Panama. Maybe the culprit was lurking in something I ate for lunch the day following my whirlwind hospital tour.
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CHAPTER TEN - What Was On My Plate?
JP was once again the driver, and gave me the cook’s tour of Panama City.
He suggested we stop at his favorite restaurant on the Amador Causeway overlooking Panama City. The causeway road is 2 lanes wide (one in and one out) and connects four small islands that were once a part of Ft. Grant, which was built in 1913 to protect canal access during WWI and WWII.
Flanking the road are a number of restaurants, shops and a marina. The one we chose was right on the waterway.
We sat in the breezeway watching the pleasure boats in the harbor while swatting flies away from our plates. Maybe one of the flies was a biologic vector. It was the last full meal I had eaten for more than a week.
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CHAPTER ELEVEN - Bumpy Road To Recovery
Eight days after arrival in Montevideo, I enjoy my first bite of empanada atun from the Confiteria La Corunesa. It is so delicious I begin to think that the ordeal has been worth it – a small price to pay for such pleasure.
Within a few days, I am able to make short walking treks through the city we enjoy so much. We split a chivito sandwich at the Oro de Rhin, a shrimp cocktail at El Palenqueil, and visit old friends at Tannat. Restaurants offer outdoor seating and the seductive scent of meats grilling on the parillada permeate the warm summer air.
Parks are filled with flowers; shade trees abound. At last I am well.
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CHAPER TWELVE - The Accidental Medical Tourist
My personal experience with “medical tourism” was successful. Although I didn’t get sick in Montevideo, I got well there.
There is much to be said in favor of seeking treatment on site for commonly occurring diseases native to a particular region.
And the quality of healthcare I received in Uruguay was quite good. Everyone who treated me was competent, helpful and quite concerned about my well being. The physical examination by each doctor was skillful and thorough.
Even though I did not speak Spanish, language was not a barrier, as an interpreter was always available through the hotel. As an additional benefit, the hotel covers the cost of a doctor visit as part of their services. The only out-of-pocket expense was the cost of medications at the local farmacia, ? A block away from the hotel; open 24 hours.
I travel to see the variety of cultures, meet new people, and eat the local cuisine. Getting sick, then getting better was part of the experience.
There are a growing number of folks who travel with the express purpose of seeking health care beyond their own borders. In 2007 up to 750,000 Americans had medical treatment outside of the US. For some the attraction was the significant cost savings, for others it was a matter of timely access – to avoid delays and waiting periods.
Americans are an “I want the best, and I want it now” society. But we’ve just added 30 million new enrollees to the ranks of covered members. If it takes 12 years to “grow” a doctor (2 to 4 years for a nurse) we will soon be facing a situation where the demand will jump way ahead of the supply of health care providers. Already some doctors are not taking any new patients (Medicare or commercial). Where will we find timely medical attention? Is medical tourism the answer?
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CHAPTER THIRTEEN - Medical Tourism: Adding It Up
If you’re thinking of joining the intrepid group of medical tourists, here are some things to consider before taking the leap:
Understand that medical tourism is mostly for elective (non-urgent) procedures, where there’s time to plan, research and tally the costs. 75% of these procedures are outpatient surgeries (cosmetic, dental, etc.) Don’t go if you’re looking to get a collapsed lung reinflated in a hurry.
Budget, Fees, Cash and Price
It doesn’t pay to travel for medical care unless you can save up to 70% of the total cost after travel expenses, and that’s a big “after”. At least one source suggests if the cost of the procedure is less than $6,000, it’s probably not worth the trip by the time you add all the airfare, hotel, ground transportation, the care and feeding of your caregiver.
Don’t forget to budget for the extra fees. Does the physician charge extra for office visits? In Panama if you’re a patient with private health insurance who is seen by the doctor in the office, there’s an extra charge. Is there an extra charge for labs, x-rays, imaging? What about medical supplies (bandages, prosthetics, compression stockings)? Is the anesthesiologist included in the fee? What about physical therapy? The list seems endless.
Bring lots of cash, and then convert it to the local currency. Make sure there’s enough to cover the quoted cost plus 10% extra for unforeseen complications. Even something simple such as taking a private car versus a grungy taxi can make a trip more comfortable.
And you can’t (or shouldn’t) shop on the basis of price alone. Safety is a big factor. Is the hospital or clinic located in a safe or convenient location? I’ve seen some tropical facilities without air conditioning, or located in the seedy part of town. How much fun would it be to lie in a lumpy hospital bed for a few days and the only programs on the television are broadcast in a language you don’t understand, or the food service is something odd that you don’t like?
I love Vietnamese food, but wouldn’t eat a plateful of sea cucumber, at any price.
Your Right-Hand Man (or Woman)
You may need to feed and house your caregiver as well as getting them to the destination. More than one article I’ve read recommends taking a family member or close friend with you. Cross out the word “recommends” and replace it with “essential”.
When your splitting head is spinning and legs seem to be made of rubber, only someone who truly cares for you would be willing to haul your stinking carcass into the nearest bathroom for a complete or partial evacuation of any orifice – followed by a hose down.
Be sure to choose your emergency contact carefully as well. Who can “drop everything, hop a plane and …”
Flight Time
Comments abound regarding the “special risks” of combining long international flights with anesthesia and surgical procedures. You should factor in extra time before getting back on the plane. Just as a diver can’t fly and dive within 24 hours to prevent the getting the bends, you need to plan for recovery time.
Let’s face it, all but the most expensive seats are cramped and crowded on today’s flights. Do you really want to crawl over another passenger to get to the bathroom with fresh stitches? Then there’s the issue of turbulence (clear air or stormy).
Don’t forget about the long winding lines at immigration and customs once you arrive. There’s nowhere to rest once you’re in line, unless you arrange for a wheelchair in advance.
Give yourself plenty of time between flights if you must change planes. You might miss your connection if the trip is planned too tightly.
On our return trip from Montevideo, we were delayed an additional 90-minutes waiting for a major storm to pass. This didn’t give us enough time to change planes in Panama City and our really good seats were given away. We hastily booked the next flight out but still missed our connection to Chicago for the final leg because the immigration lines in Houston were so long.
The Facility
Many facilities don’t seek special accreditation or international affiliations. Although they might be small, highly qualified and personal, they simply don’t want to spend the extra money on jumping through these hoops. It doesn’t mean they’re “bad”.
As of 2008 there were only 220 foreign medical sites approved by the Joint Commission International (JCI). It’s still a pretty unregulated industry. So how do you check for quality? How many times has the doc done your procedure? What were the outcomes? This may not be as transparent as you’d like. And how would you evaluate the staff – are you going to credential them? Would you even know where to begin? You could use a travel concierge for this.
Insist on the staff using a language you understand. This is almost always available for professional staff, but what about housekeeping, or the aide who fills your water glass? How about the taxi driver taking you back to your hotel?
Does the facility get government support? Government run health care isn’t necessarily the best. In fact, some researchers feel that medical treatment is only good if it’s private. Government hospitals are overloaded and the wait times can be long. They serve a wide range of patients. You could just be a number in a queue.
The Doctor
A surprising number of physicians are board certified, right here in the states and then set up a practice back home. That you could research. Vet your doctors – through a travel-planning agency. How else would you do it if you don’t have family or friends at the destination?
Technology and Procedures
Do as much research as possible before you leave home to make sure you understand the procedures. And good luck with that one.
As a managed care nurse with nearly 15 years experience in case review, I’ve worked with a number of primary care physicians who didn’t have a clear understanding of specialist’s procedures. And why should they?
Do you understand the benefits of cemented versus cement-less hip implants as it might apply to your case? Where would you get a second opinion overseas? And wouldn’t you have to vet the second doctor too?
One article cautions the tourist to evaluate whether the equipment and technology are modern. Now how would you be able to do that? Are you going to make a site visit in advance and assess the facility? What standards would you apply? They won’t have OSHA there.
Diagnosis, Medical Records and History
Know your diagnosis. I read an article recommending that you know your diagnosis and treatment needs. Well, that’s assuming cookie-cutter medicine in a one-size-fits-all scenario.
Does your doctor actually know what your diagnosis is? In a lot of cases, it’s a “rule out” rather than actual diagnosis and there could always be surprises once the procedure is underway.
These days, a physician’s office is likely to charge (per page) to photocopy your medical records. How much history does the foreign practitioner need? If you have a big file, this could get pricy.
Are there HIPAA restrictions involved in sending information out of the country?
Insurance
If you’re lucky enough to have international insurance coverage, you’ll have to bring all the necessary insurance records.
Are preauthorizations required? Who takes care of these approvals, you or your doctor? Be sure to ask your questions, and coordinate all the paperwork before you leave. But there may still be some unresolved questions regarding denials and appeals. What is your co-pay?
When You Get Back
Coordination of care will be necessary after the party’s over, and there’s always a chance of complications. Even when you receive care at home, you have to sign informed consent forms because bad things do happen. You might need to be readmitted to a hospital at home if things go wrong
You might also have to arrange rehab, say for a hip or knee replacement, or (heaven forbid) long-term care.
So do your homework well in advance of the procedure. For a list of helpful websites to research, please visit my blog at http://www.travelonz.blogspot.com and go to the May 15, 2010 entry “Medical Resources On The Road”.
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CHAPTER THIRTEEN - If You Go …
Above all, be prepared to wait; be prepared to be disappointed; and often to be pleasantly surprised.
Most importantly, be a patient patient.
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CHAPTER FOURTEEN - Happy To Be … Ever After
Chicago, 2010
Four weeks after the onset of the “virus” I saw my primary care physician in Evanston.
His working diagnosis was amoebic dysentery. Currently it is dormant and I’m feeling much better, but if it flares up again, I’ll contact his office for lab testing so the parasite can be successfully targeted with additional medication
It’s estimated that 89% of us are infected by parasites, so there’s weird comfort in realizing that I’m not alone in this. The last thing you want when traveling for medical services, is to bring back something that is going to make you feel worse.
My personal experience with “medical tourism” was a qualified success. After all, I didn’t get sick in Montevideo, I got well there. There is much to be said if favor of seeking treatment in situ for commonly occurring diseases native to a particular region, or medical tourism if you’re willing to do all the prep work
Would I go back?
I’m starting Spanish lessons next week.
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About the author:
Mary Anne Lonze is a registered nurse who has published articles on health care, and appeared as a guest of Neil Cavuto on FOX Business News, and FOX & Friends television. She is also a freelance travel writer, armed with a camera. Her greatest treasures are her friends and a growing collection of Apple toys. Mary Anne lives in Chicago with Tom, the love of her life.
Connect with Me Online:
Twitter: http://twitter.com/travelonz
My blog: http://travelonz.blogspot.com