Getting Medical Help Overseas

Accidents happen, even in paradise, but you don't have to let injuries become disasters.

- By Karen Shelanski and Samuel Shelanski, M.D.

Know Before You Go
Emergency Decisions
Emergency Evacuation
Be Prepared To Pay
Playing Doctor: Medicine in the Bush

Road Rules: Your Medical History | Travel Assistance Services

Divers tend to have one-track minds when it comes to potential injuries. We focus on reducing our risk of decompression illness (DCI), but the stats say when traveling overseas, we're more likely to be injured missing a stop sign than a safety stop.

Accidents and illness can happen anywhere, even in paradise. That's why it's important to know how to find qualified medical help overseas, from doctors who speak your language.

Know Before You Go

Look for a doctor or medical facility before an accident occurs. A little time spent familiarizing yourself with the availability of medical help in your destination can save you endless grief in an emergency. Organizations that can help you in your search include:

·  Divers Alert Network. In addition to answering questions about DCI, DAN's information line (919-684-2948, ext. 222) can help you identify medical and rescue services in many popular dive destinations (see: "Your Emergency DCS Plan," RSD, Jan./Feb. '99 or on the web: www.scubadiving.com/training/medicine).

·  International Association for Medical Assistance to Travelers. IAMAT is a nonprofit network of 800 English-speaking doctors in 125 countries and territories. All are western-trained and have agreed to treat travelers according to a set payment schedule. IAMAT membership is free, although donations are encouraged. Call (716) 754-4883 or visit their web site at www.sentex.net/~iamat/.

·  The International Society of Travel Medicine. ISTM provides a list of more than 500 travel clinics in 44 countries. The directory is free, but caregivers may not speak English and there is no quality of care standard or regulation of fees. The ISTM listing is available on the web at www.istm.org, or you can obtain a printed booklet by writing to ISTM, P.O. Box 871089, Stone Mountain, GA 30087-0028. For more information, call (770) 736-7060.

·  The U.S. Government. Make sure you know the location of the nearest U.S. embassy or consulate to your destination. There are 240 of them around the world, and they can help you find a doctor or dentist, contact family in an emergency, and even help you wire money from home in a pinch. For a listing of U.S. embassies and consulates, see the Consular Information Sheet for your destination on the World Wide Web at travel.state.gov/travel_warnings.html. These listings also give you an idea of the level of the medical facilities available in your destination.

(Top)

Emergency Decisions

If you do suffer a serious injury or illness while abroad, you have a major decision to make: Should you receive treatment there or call for evacuation? The answer depends on where you are and upon the severity of your injury. You should not be concerned about treatment at major hospitals in developed nations. In parts of the third world, however, it is best to receive only the minimal emergency treatment required to stabilize the situation, then arrange to be transferred to the nearest modern medical center. If local care is required:

·  Don't panic. Very few clinics are eager to perform unnecessary surgery, and blood supplies for the most part are very safe, even in less developed countries. However, if a situation isn't life-threatening, don't accept surgery or blood transfusions.

·  Document everything. Should you be treated in a foreign hospital, make sure that you get full details of your treatment, including X-rays, diagnostic tests and the generic name of any medications.

The physician and hospital may regard this as a sign of distrust and be reluctant to provide this information. Reassure them that you simply want to have as complete a report as possible for your personal physician and insurance claim. This explanation will usually persuade a hospital or doctor to release your records, but expect to pay for the copies.

(Top)

Bugging Out: Emergency Evacuation

If emergency evacuation is required, you face two big problems: 1) arranging the right transportation and 2) paying for it. Evacuation costs start at $10,000 on commercial flights, $25,000 to $50,000 on a private air ambulance. The worst part: the plane doesn't move until payment is arranged.

Air evacuation will be much easier if you have a supplemental insurance policy designed to cover it. With one call, you can arrange evacuation without the hassle of negotiating payment--if you have the right coverage.

There are several travel assistance services and policies available to business and vacation travelers (see sidebar) but the best--and cheapest--option for recreational divers is a good dive insurance policy (see "Dive Insurance: Are You Really Covered?" RSD, Jan./Feb. '98). At $80 a year, even the most expensive of these policies is a bargain, but it's important to understand what is and isn't covered.

• All policies offered by the Divers Alert Network (DAN) carry $100,000 in evacuation insurance by TravelAssist. These policies cover the cost of evacuating the injured policyholder and uninjured immediate family in the case of any medical emergency--diving or non-diving related--as long as it occurs more than 50 miles from home.
• PADI insurance plans offer evacuation coverage from Assist America ranging from $50,000 to $125,000, but only the Platinum plan covers non-diving injuries and the cost of evacuating uninjured family members.
• Diver's Security Insurance (DSI) offers its Class C evacuation policy, which covers up to $15,000 in emergency evacuation, but only for the insured and only in the case of dive accidents.

If you don't have any form of emergency evacuation coverage, call the nearest U.S. embassy or consulate or your insurance carrier. They should be able to help make arrangements for transportation back to the United States or to the nearest major medical facility, but you'll be responsible for payment up-front. If you're having trouble, have a contact person in the United States get in touch with the U.S. State Department's Overseas Citizens Emergency Center at (202) 647-5225.

(Top)

Be Prepared To Pay

Haggling over price is fine when you're shopping at the local straw market, but not when you're bleeding at the emergency clinic. Have a plan to pay for medical care that doesn't rely on whipping out your HMO or primary insurance card. Why? Your policy may not cover overseas expenses.

• Read the fine print. Coverage varies from company to company, even policy to policy. If you talk to a company representative, get all promises to pay in writing.

Older divers should also be aware that Medicare insurance won't cover any medical expenses or hospital costs incurred outside of the United States.

• Carry cash. Even if your insurance coverage does travel with you, the local clinic or hospital might not accept it. Most will demand payment up-front. Small sums can usually be covered pretty easily with available cash or traveler's checks, but it's advisable to carry a credit card with at least $2,000 in available credit to cover more serious situations.
• Examine the bill. No matter how you pay for your treatment, make sure to get an itemized bill. Your insurance carrier will most likely require such documentation to reimburse you. If your policy covers overseas treatment, take copies of all your insurance cards, and even claim forms with you to be filled out at the time of treatment.
• Make a donation. If you're fortunate enough to receive treatment in a country with socialized medicine, or in a clinic where the treatment is free, make a suitable donation to the hospital or a local charity to cover the costs. This is not only an appropriate gesture of goodwill, but will encourage them to continue treating travelers in need.

(Top)

Playing Doctor: Medicine in the Bush

The closer you are to a major population center, the better your odds of obtaining decent health care. But out in the bush, you may end up dealing with medical emergencies on your own. If you're headed to the jungle or an uninhabited atoll:

• Pack a complete first-aid kit. In very poor or remote areas with limited medical service, instruments and syringes may be reused without being properly sterilized between patients. If you have your own needles, syringes and sutures in a first-aid kit, ask the doctor or nurse to use them instead. If you do not see the supplies removed from a sealed, sterile pack, ask to have them sterilized for 20 minutes.
• Know how to use it. An entire hospital full of supplies is no good if you don't know a suture from a scalpel. In extremely remote locations, it helps to have at least basic first-aid training. It's also a good idea to have an evacuation plan in mind and learn to say "I need a doctor" in the local lingo.
• Know your medicines. When you are stuck handling a problem yourself, remember that many medicines, particularly antibiotics, that are available by prescription only in the United States can be purchased over-the-counter in other countries. This can be useful at times, but it is also potentially dangerous.

Even if a medicine looks like the one you purchase at your local pharmacy, it may not contain exactly the same ingredients. Drugs manufactured in developing countries may not be subject to the strict quality controls available in the United States. Whenever possible, stick to brand names that you know and purchase them in sealed or tamper-proof containers.

You must also be sure that you're not buying expired or outdated medicine. The older a drug gets, the less potent it becomes, and some drugs become toxic as they break down.

·  Skip the witch doctor. No matter what you do, avoid local or herbal remedies. Most are useless at best and dangerous at worst.

(Top)

Road Rules: Your Medical History

If you have a serious or complicated medical problem, consider taking with you:

• Medical ID. A bracelet or tag is available from the MedicAlert Foundation International. The ID includes a 24-hour hotline where doctors can obtain your medical history. The service costs $15 annually, plus the cost of the ID bracelet or tag. For more information, call (800) 432-5378, (800) 344-3226 or (209) 668-3333. You can also visit their web site at www.medicalert.org.
• Doctor's Letter. At the very least, people with pre-existing medical conditions should carry a letter from their doctor describing the illness and any medications they are taking.
• Enough Pills. If you are taking any medications, take enough to cover you for the entire trip, plus an extra week or two just in case. Have the pharmacist label the pill bottles with the generic name of the drugs, as trade names may differ from country to country. And keep the pills in the original vials to avoid confusion.

(Top)

Travel Assistance Services

Frequent overseas travelers may find it wise to invest in a commercial travel assistance service. Although many of these services are geared to business travelers, they may come in handy for vacationers, too.

Fees and services vary, but most provide a 24-hour hotline to help arrange local medical help or emergency evacuation. Some even sell various forms of travel insurance including emergency evacuation policies. When you're evaluating different services, it's important to ask these questions:

• Who answers the hotline? Some services have registered nurses who can evaluate your condition and help with a diagnosis over the phone. Others are answered by receptionists who can only refer you to local medical care or evacuation services.
• What does the service know about its physicians? You want a service with western-trained physicians, and one that knows exactly what services they can provide and at what fees.
• How are physicians paid? It's important to understand that most referral services are not insurance. In most cases, you will still be responsible for the bill, usually up-front.
• What are evacuation coverage limits and how are they paid? If you're buying supplemental evacuation coverage, look for a policy with high benefit levels and one that pays providers directly.

Examples of assistance services currently available include:

Global Emergency Medical Services
What they do: Provide a 24-hour medical help desk hotline answered by a registered nurse, maintain medical records, assist with pre-trip planning and maintain a provider network with western-trained, English-speaking physicians in 190 countries. Also provide direct-paid emergency evacuation insurance.
Cost: $95 for an annual membership; $35 for one-time service.
For more information: 2001 Westside Parkway, Suite 120, Alpharetta, GA 30004-7408. Web: www.globalems.com. Tel: (800) 249-2533 or (770) 475-1114.

AEA International/International SOS Assistance
What they do: Offer a variety of personal and medical travel services, including pre-trip planning information, medical referrals, medication replacement service, travel insurance and 24-hour emergency hotlines to arrange local medical help or evacuation.
Cost: Varies according to services and membership. Per-trip coverage starts at $55 per person; annual memberships at $280 per person.
For more information: 8 Neshaminy Interplex, Suite 207, Trevose, PA 19053. Web: www.intsos.com. Tel: (800) 523-8662 or (215) 244-1500.

Personal Physicians Worldwide
What they do: Compile and review your medical history, then provide that information to a local physician fluent in your language who is on call 24 hours a day during your stay.
Cost: First trip, $500 for up to two destinations.
For more information: 815 Connecticut Ave. N.W., Washington, D.C. 20006. Web: www.perÊsonalphysicians.com. Tel: (301) 657-8114 or (888) 657-8114.

Editor's note: This list does not include all services, nor does it imply endorsement by RSD or the authors.

(Top)

Send all comments and suggestions atwebmaster@InternationalDream.net
© International Dream 2000
tutti i diritti riservati.