What To Do If You Experience a Medical Emergency While Travelling (Especially if you are Travelling Solo!)

By: Nanette Fairley

August 14, 2023

The thought of having a medical emergency while travelling can be scary.  It is something I have thought about a lot as I travel solo (spending most of this year overlanding in my Toyota across South America).  I am driving on difficult terrain at altitude, hiking and climbing and traversing crazy cities where the road rules seem non-existent!  What could possibly go wrong!?!?!?!?!

I am also a pretty organised person so have done quite a bit of planning in this area prior to starting the journey.  As I get older, the likelihood of a health issue while travelling seems likely to increase. So my strategy was to prepare for the worst but expect the best. Feeling well prepared, I put it out of mind and enjoyed the journey!

Last month I was hiking on Isla del Sol on Lake Titicaca in Bolivia.

I had been feeling pressure build up and some discomfort in my abdomen for a couple of days, but I ignored it thinking it was probably something I ate.  The day after the hike I drove about 8 hours to La Paz, the capital city where I had booked an Airbnb for a few weeks.  That night the pain got somewhat worse and I started vomiting.  Now I was sure I had some intestinal parasite! Just great!  ☹

Arguing with myself if I really needed a doctor or not, I asked my Airbnb host if they could recommend a gastrointestinal specialist in La Paz. They recommended a specialist who was actually within walking distance of my apartment.  I checked out the embassy websites and I saw his name on the US list of medical professionals which was another tick for me.  I asked my Airbnb host to make me an appointment as my Spanish is not good enough to have a phone conversation.  The doctor had thoughtfully brought in his daughter, also a doctor and fluent in English, to translate.  He sent me for an ultrasound, lab work and a cardio check (which I thought a little odd) and by the time this was all completed and I got back to his office a couple of hours later, there was a look of concern on his face.  Remember, I was sure I had some kind of weird intestinal upset.  So I was more than a little shocked when he diagnosed acute appendicitis with the need for surgery TODAY!

So here I am in a developing country, not able to speak the language, no chance of flying anywhere else for surgery as it was too dangerous, far away from family and friends……..I have to admit my usual calmness made way for a mini melt down!  Going under general anaesthetic and having a few nights in hospital (something I had never done before), filled me with dread!  I started catastrophising about what level of care I might receive in a hospital here……

I am very lucky to have brothers who are doctors, so I rang one of them at 2am in the morning Australia time to talk it through and the conclusion was I really didn’t have a choice.  My Bolivian doctor, was so very kind, and although we couldn’t communicate very easily, he offered to drive me to the hospital.  He didn’t think it was a good idea to go back to my apartment to get a toothbrush or a change of clothes – so, two and a half hours after I initially presented in his office, he had booked emergency theatre time and off we went.  On arrival at the hospital I started to calm down.

It was clean, modern and the young doctor who admitted me while my doctor went to scrub for surgery, spoke English.  He pretty much stayed with me until I was in the operating theatre and being knocked out by the anaesthetic.

There were many more acts of kindness over the 3 days/2 nights I stayed in that hospital and a few weeks recovery time post surgery.  From the nursing staff, my surgeon, the nutritionist in the hospital, my Airbnb host and a lovely physiotherapist who also popped in to see how I was (she was fluent in English as most of the nursing staff only spoke Spanish), I was incredibly thankful for their support and care.

The moral of my story……….prepare for the worst but expect the best!  Here are my top tips for managing a medical emergency when you are travelling, especially if you are travelling solo.

1. Be Well Prepared Before You Start Travelling

• Make sure you have the right travel medical insurance for you and UNDERSTAND IT!
  • • Before you get on that plane ensure you have travel medical insurance which is different from travel insurance. The later normally covers loss of your stuff or flight delays etc.
  • • Check what your medical insurance does and does not cover while travelling. For example, there are many stories of young people who have horrible scooter accidents in places like Bali and find out when they are in hospital facing medical bills of $250,000+ that they will not be covered.  If you are going rock climbing, or paragliding, check that your insurance covers these activities.  Also check what countries your insurance covers as many policies require extra coverage for the USA for example.  Ask yourself – do I have the cover I need?
  • • If you are going off-the-beaten-path to countries with less infrastructure and inadequate healthcare, consider buying medical evacuation insurance. I have this in my coverage because I want to be airlifted to a country of my choice if I have serious injuries.  However, many insurance companies will only consider repatriating you before treatment, or stabilisation of your condition, when the risk of you staying where you are is greater than the risk associated with moving you.  So be cognisant of that when discussing repatriation coverage with your insurance company.  I know in my recent case, I was not permitted to fly anywhere due to the very real risk of my appendix bursting, so even though I have repatriation coverage, it wouldn’t have helped me in this instance.
  • • Good travel medical insurance often includes a 24/7 call centre with physician support. Do you know the call centre number?? I went to Uraguay earlier this year with a friend who got sick in Montevideo.  He simply asked his medical insurer via whatsapp where a good nearby hospital was and was given an address that was less than 100m from our accommodation.  I was a little jealous as, although I think my medical insurance is very good, they do not have that facility.  Also do you have telehealth options with your primary care physician/general practitioner?
  • • Know what the fine print says if you are part of an organised travel group. For example, what happens if the group moves on leaving you in hospital?  This will usually be addressed by a reputable travel company, but good to know beforehand to lessen the stress in the moment.
  • • Be clear about the details of your medical insurance claim process. Don’t wait until you are in pain in a foreign hospital to try and work it out.  I hadn’t claimed anything big on my medical insurance before this surgery but I knew the process and what I needed to do and that was comforting.
• Go to your doctor before you travel.
  • Consult with your primary care physician, general practitioner or a travel medical specialist well before travel. Some of the things that will be useful from this appointment include:
    • • If you do have an ongoing medical condition, ask your doctor to write a report explaining it and the treatment you are on, if any. If you will be away for a while, it would help if you have it translated into the language of the country you will be in if possible.  I used Google Translate to read all of the medical reports I got in Bolivia as they were all in Spanish!
    • • Discuss medication for early self-treatment, e.g. for diarrhoea or altitude sickness. You can also discuss how to prevent blood clots on long flights, safe food and water choices etc.  Right at the beginning of this year I travelled with my 18 and 19 year old nephews and I had a very well stocked first aid kit on that trip! I really felt the weight of responsibility for them as we were going to a country where the water needed treating and malaria was a very real threat.
    • • Ensure your vaccinations are up to date. I do this during my annual well woman check-up each January. I take my vaccination card and review it with my doctor and she orders more if needed. I recently met a traveller who was bitten by a very crazy dog on a street in a small town in Chile.  He wasn’t up to date on his tetanus so had to take the time to find where this was possible.
  • Prepare a medical travel file.
    • Consider the essential information that this file should contain. When I am backpacking I normally have it only electronically on my phone/ipad.  But if you have more luggage space, like I do in my car, I have it paper-based as well. But it is important to make sure it is all scanned and available on your phone electronically (I was rushed to hospital – so only had my phone with me – not even a change of underwear or a toothbrush, let alone a folder with all my paperwork in it!).  Some of the things you might want to include are:
      • • A brief one pager with all the critical information a medical professional might need to know about you and put it down on a piece of paper – blood type, allergies, necessary medication, name and date of birth, etc.
      • • If you have any pre existing conditions, especially those you are on medication for, include the doctors’ letter mentioned above in this file.
      • • List out all the contacts that are important – your emergency contacts, your primary care physician/general practitioner, health insurance contacts including the 24/7 phone number or whatsapp, etc.  It is also important that your emergency contacts are easy to find on you if you have an accident and are unconscious.  You can write them inside your passport (most have the space to do this).  I also have mine stuck to the visor in my car.  I met another solo traveller recently who wears dog tags around his neck with his emergency contacts and I thought that was a good idea too.
      • • Also, so you don’t forget it, list the process for making a medical claim. Sometimes it can take wading through a lot of written information to understand it.  Medical insurance companies may not make claiming very easy!  Simplify it, perhaps in a flowchart or list, so it is simple and easy to follow when you are under the stress of a medical emergency.  This is especially important if you must get approval from your insurer prior to surgery, for example.
      • • Include copies of your health insurance card and passport (the originals will usually be on you, but best to have back ups should they get lost).
      • • If you have an advanced health directive (what to do in case you are incapable of making decisions about your health) have a copy of that too.
      • • Include a few blank medical claim forms if your insurance claims do not go straight online (you DO NOT want to have to find a shop that will print them for you when you are unwell or recovering).

• Other Preparation That You Might Find Helpful
  • • Know what your governments website says about dealing with medical emergencies while abroad. I know that many embassies do not have the resources to help travellers – so don’t count on them for immediate support.
  • • Ensure you have enough prescription medication to cover your trip and, as mentioned above, carry a letter from your doctor explaining why you need it. It is important to keep this medication in its original packaging.  Check your medications are permitted wherever you are travelling to. For example, Codeine is a controlled drug in many countries, so you will need permission to take it into the UAE, for example.
  • • Some medical facilities will require payment up front before they treat you. If that is the case know if your insurance will step in immediately or whether you will need to provide your credit card initially.  If you are in need of urgent surgery, you don’t want to be trying to work out then how to cover the required upfront payment.
  • • Ensure your electronic set up will support you – e.g. if you can communicate with your insurer via Whatsapp, have you downloaded it and know how to use it? If you have to scan all reports, receipts etc. to support a claim, do you have a scanner on your phone and do you know how to use it?  After my surgery in Bolivia, I had to scan some 22 documents to send to my insurer.
  • • If you are travelling with others, make sure you know what insurance they have and encourage them to know the details and/or have it documented. I once arrived in the emergency unit at a European hospital with a travelling companion who was in a lot of pain.  However, she was unaware if the insurance was pay and claim or if it was necessary to contact the insurer up front.  That is not the time to be trying to find out!

2. Tips for Managing a Medical Emergency When It Is Happening While Travelling
   • • OK I can say this in hindsight, but you know you. Don’t ignore health issues while travelling.  Seek help if you feel something is not right. I probably left my abdominal pain a bit too long before seeking help.
   • • Know what the medical emergency number is in the country you are travelling in – e.g. in the USA it is 999 and in the EU it is 112. In Bolivia, while I didn’t need to use it, it is 118.  But you don’t want to be trying to find that out when you are experiencing some kind of medical emergency.
   • • If you are going to be in one country only you may be able to do some research prior. If not here are my best tips for finding the right medical support in an unknown country:
       • Check embassy websites etc US, UK. Usually embassies don’t like to recommend doctors, but they often have lists on their websites.
       • Does your medical insurer have a list of doctors? Like my friend was able to whatsapp his insurer and was given a close by hospital to go to in Montevideo.
       • Ask your hotel or Airbnb. Hotels often have an arrangement with a general physician and they will be able to recommend specialists should you need them.
       • Ask in travel groups, especially country travel groups you are in online e.g. Facebook, Instagram. I am a member of a number of South American overlander Whatsapp groups and I know if I needed some recommendations, I could ask there.

     • Keep all receipts, reports, scans, lab results, etc. etc. If you have prepared well prior you will understand what paperwork your insurer needs e.g. a hospital discharge report or all of your credit card receipts etc.  As mentioned above, I had 22 pieces of paper to keep track of during and after my medical treatment in La Paz.
     • Have cash on you and a credit card with a decent limit. I had to pay for all my lab work and the ultrasound etc. upfront with cash as that is all that was accepted at the medical centre I found myself in in La Paz.  Also, if your medical insurance is pay and claim, you may need to put the whole hospital bill on your credit card before you will be discharged. Know beforehand how you might cover a large hospital bill so this isn’t another form of stress when you are already feeling poorly.
     • Ask questions as you would at home and advocate for yourself, particularly if travelling solo. This, however, can be challenging if you don’t speak the language.  If there is no one to translate e.g. from your hotel, Airbnb or the medical clinic, make sure you have a local sim or use wifi in the medical clinic and use Google Translate.  It is better than nothing!  Sometimes your medical insurance will cover the cost of a medical translator but not always. As outlined above, know what is covered well before you travel.
     • If alone, before you go to your medical appointment, write down the words that will help you describe the issue and its severity. Again Google Translate will help and, if you have the luxury of time, it will make the appointment go more smoothly and ensure the doctor really understands your symptoms to make an accurate diagnosis.
     • Once your treatment is completed take time to recover. Don’t try to resume travel too quickly or you may suffer a relapse. I was lucky this time in that I was able to extend my Airbnb for a month and was able to recover and have important post-op appointments with my surgeon.

Finally………

99% of us will not experience a medical emergency when travelling.  However, should it happen, to decrease the stress and help the medical professional do their best work for you, the tips above will help.  With a little preparation up front you can avoid the worst stress of a medical emergency and focus on getting treatment and healing.  Of course, there are some things you will not be able to plan for, but if you have all of the above covered, it will take an enormous amount of stress off you.  Now that I am recovered I was able to see quite a bit more of Bolivia and have recently crossed the border to spend a couple of months in Peru.  My claim for reimbursement was paid just 3 weeks after I submitted my paperwork and there were no questions about lack of documentation etc.  And, of course, a huge thanks you to my surgeon for doing such a great job on the day! 😊