If you are travelling for longer than a few weeks, the chances are that you will end up getting sick at some point in your travels. For most people, this is likely to be limited to some form of food poisoning or traveller’s diarrhoea. For an unlucky few however, it can be something more serious.
For me, sickness struck when I was travelling through Myanmar with my girlfriend’s parents. It started as a sore throat. Luckily we carry a decently stocked medical kit, so when the pain became nagging I took an ibuprofen and forgot about it. Over the next few days, the pain in my throat continued to get worse and I increased the dose of ibuprofen and bought myself some strepsils, not wanting to disrupt the family holiday or Emily’s time with her parents who hadn’t seen her in months.
Within the next day or so, the pain had gotten to the point that I had to brace myself each time I swallowed. Even at full doses of paracetamol combined with ibuprofen, it didn’t touch the pain. Solid food hurt too much to even consider, so I ate yoghurt and ice-cream and tried not to let on. I took myself off to see a local doctor. The clinic doctor looked in my mouth from a distance and quickly declared that I had tonsillitis and laryngitis. He prescribed me 3 separate antibiotics to take over the next 3 days and gave me some throat lozenges.
Over the next 2 days, I took my medication and waited to start feeling better. During this time I hardly left my room, as speaking hurt too much to interact with anyone and eating was impossible. However, despite taking my medication as instructed, I continued to get worse. I even had to tap into the emergency supply of codeine that I had brought with me when the over the counter painkillers stopped working at all.
A few days later, when it became apparent that the antibiotic combination I had been prescribed was not working, I decided to see another doctor, this time in Inle Lake. This doctor gave me the same cursory examination, confirmed the initial diagnosis and changed my antibiotic regime. At no point in either appointment did anyone actually look at my throat.
By this point, the pain was so bad that I would wake up halfway through the night as soon as my painkillers had worn off. After another 3 or 4 days had passed, I was starting to become scared and a little desperate. By this time, we had arrived in Yangon and I had the opportunity to see a western standard doctor.
At the cost of $100, I was able to see an Australian doctor, employed by the Australian Embassy. It took him less than a minute to properly examine my throat and diagnose me with a particularly nasty peritonsillar abscess which required immediate treatment.
He immediately booked me in with an ENT in Yangon, but he was unable to perform the necessary procedure with the equipment available to him. This meant that I had no other option but to book an emergency appointment with an ENT surgeon in Singapore the next day. This meant cutting my trip to Myanmar short by two days and leaving my girlfriends parents alone in Yangon. But alas, I had no choice. In the end, I required a surgical draining of the abscess and 3 days in hospital for IV antibiotics and a drip due to severe dehydration.
Having time to reflect on what happened from my hospital bed, I decided to write this article to pass on some of the lessons that I have learnt.
1. Get the best travel insurance you can afford.
In that exciting time before you start your travels, the last thing on your mind is travel insurance. With all of the costs of booking flights, buying new clothes and paying for your vaccinations, it can be tempting to buy a cheaper travel insurance policy in order to save money. After all, it would never happen to me.
Take it from me, there are an almost unlimited number of things that can go wrong when you travel. From unexpected falls to dodgy street food, worst case scenarios do happen and if things do go wrong, you will want the best care you can get because getting sick can get expensive. Fast.
Getting sick in Myanmar ended up costing me over £4000 after I was left with no other option but to fly to Singapore for emergency surgery. After the surgical procedure and three days in hospital, I was so glad that I had the gold standard insurance from World Nomad. Coming from the UK, the way that healthcare worked in Singapore was a shock. You are billed for every tablet, every cup of tea and every fleeting appointment with a consultant.
Tip: Get your insurance from a backpackers insurance company. such as World Nomad. These companies are often formed by people who travel and they have a better understanding of how things are different in different countries and tend to be a little more flexible in their approach to claims.
2. Trust your gut.
Remember to take any advice from locals with a pinch of salt. Whilst I was suffering from the early stages of my condition, I was advised to drink ginger tea. Then to drink warm water. Don’t take the old wives tales in place of medical advice.
Having said that, try and take any diagnosis from a local doctor or nurse with a pinch of salt. If you are giving you a diagnosis or explanation that doesn’t make sense, don’t feel scared to get a second opinion. I was misdiagnosed twice in Myanmar but medical staff who, in retrospect, did not complete a full examination of my throat and put me on wildly inappropriate antibiotic regimes.
The only person who knows how you feel is you. You also know your own pain threshold and past medical history. Not once in my travels did any local doctor take a medical history from me. If you believe you are seriously ill, don’t be afraid to find seek a second or even third opinion.
3. Roles don’t work like they do in the UK.
-Just because someone works in a local pharmacy doesn’t make them a pharmacist.
Just because someone is working in a clinic doesn’t make them a doctor.
Just because someone is a doctor doesn’t make their training up to date.
Make your own assessment of the situation.
4. If symptoms do not start to improve after a few days seek further help
If you have seen a local doctor and your condition is still getting worse, seek a western standard doctor’s medical opinion. Find a doctor who has qualified in Europe, Australia or the USA. You can usually look on the clinic’s website to look at the profiles of their doctors. I say this because it was only when I saw an Australian doctor that I was properly diagnosed and informed that I needed emergency surgery.
In south-east Asia, you will often see separate ‘tourist doctors’ or “international” hospitals. Whilst it seemed weird at first, having seen the public doctors in several countries, there is a real training and knowledge gap between of many doctors training in Europe, America or Australia and those in some of the less developed countries. Try and get to one of these places if your condition continues to deteriorate.
Tip: Google is a great place for finding out which is the best hospital / clinic in the area.
5. Be careful you are not just masking the symptoms of your condition with pain relief.
You can buy some pretty strong painkillers over the counter in some countries, such as Tramadol, Codeine etc. As such, it can be easy to relieve the symptoms of any underlying medical condition by simply increasing the dose of painkillers.
During the time I was repeatedly misdiagnosed in Myanmar, I was slowing increasing the doses painkillers due to the deterioration in my condition. Once I obtained codeine, however, this was enough to totally mask the pain. Had I had access to this before I was properly diagnosed, it could easily have led to a delay in seeking medical assistance.
If you are taking pain relief for more than a few days you need to seek medical help.
6. The best care may not be in the country you are in.
When it comes to medical care, you need to keep an open mind as to what the best option is. The standard of medical care is not equal in all countries. For example, the best hospital in Myanmar was like going back 20 years in the UK. I heard from friends we met travelling that the public hospital in Laos had cats and dogs wandering around the emergency room.
Yes, I know it sucks to cut a trip short, but serious complications from anything surgical suck way more. Another thing to consider is that if your condition deteriorates further, you may lose your window of opportunity to fly. If your condition is deteriorating, you need to make a decisive decision and act on it quickly.
7. Keep your insurance company up to date.
Obviously, this does not apply to anything potentially life changing or life threatening. In those situations, you need to seek urgent medical care and worry about insurance after the fact.
For anything less serious, you need to make sure that you keep your insurance company up to date. If you are intending to seek medical care in another country, you should always inform your insurance company before you fly. Find their emergency phone number on their website and call them. You can make skype phone calls for a few pennies if you do not have access to a mobile phone.
I know it is scary being ill and the last thing on your mind is insurance terms and conditions, but trust me, future you will thank you.
If you cannot call them, send your insurance company a short email setting out the details of what has happened and notify them that you will provide them with additional information in due course. Try and avoid giving specifics which may later change. It is ok to be vague at this stage, especially if a diagnosis is unknown.
This is especially important if you intend to seek treatment in another country. Most insurance providers require prior authorisation by them to justify seeking treatment in another country due to the increased cost of such measures. If you have been recommended this option by a doctor you have seen, try and get this in writing from them, or at least make sure you have their contact details so they can confirm this at a later date. In order to be safe, check the wording of your policy or contact your policy provider to clarify what is required.
8. Keep copies of everything.
And I mean everything. Medical notes, referral letters, admission letters, invoices, receipts for payment etc. Many insurance companies require original documents to be provided in order for your to make a claim.
Tip: Also, make sure you keep your boarding card stubs when you fly. I have been asked to provide these to my insurer when making a claim before. Also, we were oddly informed that a passport stamp would not be sufficient as proof of having entered the country.
NB: I would like to add this: I am not, in any way, saying that all doctors who practice abroad are bad doctors. Nor am I saying that all doctors who are western educated are superior. The issue is one of study, standards and on-going training. Having worked in healthcare regulation in the UK, I am aware of the training standards in Europe, Australia and the USA. As such, this is why I recommend doctor’s with this background if you are seeking a second opinion.