Adventures with International Medical Care

This post was originally posted on 12/12/2019 and revised 6/15/2021.

Our roving retirement hasn’t been without its mishaps. Any time you travel, you could need a doctor for a sprained ankle, a stomach bug, or in my case, major orthopedic surgery. These would all be classified as emergencies, and would probably be covered by your regular medical insurance. Most of the time we just pay cash for medical services. Some of the time our US-based employer-sponsored medical insurance even reimbursed us. But for chronic or ongoing stuff, we realized that we didn’t stay anyplace long enough to address all of our health concerns.

Since we have already purchased expatriate medical insurance for next year, we know we will have to stay in one place long enough to establish some medical relationships to address our ongoing concerns.

This assumption turned out to be incorrect because we couldn’t stay abroad as planned because of Covid. Fortunately, our insurance company gave us a one-time opportunity to add full US coverage to our policy starting in June of 2020. It doubled our premium but it allowed for my femur revision surgery. I’ve described more about our roving medical experiences in Fall in Victoria Falls.

Medical and Travel Insurance for Travelers described our understanding of the different insurance options, but in many cases, you can pay cash for services and get medication over the counter while abroad.

Seeing the Doctor in Thailand

Our first experience with foreign health care providers was in Thailand. Mike and I were on a scooter in Koh Tao and we had a “glancing” collision with a pickup truck. Unfortunately, when Mike tried to push us away from the truck with his hand, naturally, his wrist started hurting by the time we got back to the room. So that evening on our way to dinner, we passed a small medical clinic and we decided to go in. For about $25 Mike saw a doctor who manipulated his wrist and pronounced it not broken. We declined the anti-inflammatory drugs they offered because we knew we could go across the street and get the same drugs directly in the pharmacy.

Medical Care in Zimbabwe

Right after I fell down on the way to Victoria Falls, our guide mobilized the park staff to get a stretcher so I wouldn’t have to lay on the ground. They called the ambulance and the EMTs were very attentive and happy, they did all of the regular EMT stuff, like ask questions about my health, medications, and start taking my blood pressure.

The EMTs started my IV, checked on me regularly over the next eight hours, and continued to take my blood pressure. They also prepared me for transport and stayed with me until they transferred me to the flight doctor. They even made sure all of our luggage was loaded on the ambulance and directed Mike to immigration with our passports once we arrived at the airport. Overall, I was really impressed with the knowledge and professionalism of the EMTs. Just before we left, Mike was asked to pay the local clinic $240 for the X-ray, doctor, nurse, and drugs.

Airlift to Johannesburg

The flight doctor and nurse were just as attentive as the EMTs. They monitored my vitals the entire flight and even administered pain medication that the EMTs couldn’t do. On arrival in South Africa, Mike was again taken to a private immigration official who stamped our passports and the flight crew made sure our luggage got in the ambulance. The flight crew did a handoff to the local EMTs who stayed with me all the way to the hospital in Johannesburg where they did a status handoff to the hospital staff. All of this was extremely organized and very timely, with no waiting involved.

Medical Care in Johannesburg

We arrived at the hospital after 9:30 pm so it was pretty clear that I wasn’t having surgery that night. At that point, I just wanted a comfortable bed (anything other than a hard gurney in 90-degree heat). Mike was able to find a relatively comfortable recliner that he put next to my bed for the night. He chose to stick around until we were told about surgery. That night they also put my leg in traction, which made it feel much better.

The first thing the next morning, they took me to have an X-ray, where the transfers to and from the bed were super painful but shortly thereafter they started prepping me for surgery. They took blood, I met the surgeon, the attending physician, and the anesthesiologist and they explained what would happen after surgery. Since I have had surgery before, I knew what to expect. In this case, everything seemed to be going just as it did for all of my other surgeries. That was comforting. As usual, I didn’t get the nerve block that I asked for ?. I guess all of the metal in my back is intimidating.

After Surgery

The hospital I was at had a policy of keeping you in something they call High Care after surgery. It is like recovery but longer and louder. There were lots of nurses, called “sisters”, and nursing assistants, who seemed more interested in filling out this giant paper at the end of my bed than making me more comfortable. There was an easel-like desk at the foot of my bed and a double-sided paper that was at least 4 feet by 3 feet. No kidding, and you can imagine the noise it made turning it over. Then, they pricked my finger every 6 hours or so to test my blood sugar. When I complained and told them I had no history of diabetes, they said it was the policy. I couldn’t wait to get out of there and back to my really nice private room.

Recovering

I was finally returned to my room where I could get some sleep and start physical therapy. By this time, Mike was staying in a hotel nearby and sitting with me most of the day. The surgeon and the attending physician came by every day and even gave Mike advice on where to buy wine and places to eat. The doctor even told him he should buy some wine and bring it back to the hospital so I could have some. That would never happen stateside. I thought the food in the hospital was quite good even though I didn’t eat much.

The physical therapist came by every day to make me walk, the usual kind of torture. The sisters and their assistants were generally helpful and fairly quick to respond when I pressed the call button. Overall, my 6-day hospital stay was pretty much what you would expect, which was very welcome and a little surprising in itself. They let me stay until I felt ready to leave and provided great care the entire time and I was never nervous about having such extensive medical care, halfway around the world, in South Africa.

Final Thoughts

Overall, we have found medical care abroad to be pretty good. We never wish to use it, but we are glad it was there when we needed it.

At the time of the incident, it was the travel insurance company (IMG) that approved all coverage and made transport and treatment possible. However, it turned out that our COBRA coverage through Mike’s employer actually wound up paying for all of the medical expenses, and IMG paid for the Medivac.

Here is the caveat, the surgeon who performed the surgery did a poor job. At the time we thought he was pretty cocky but since I got American-made parts I hoped everything would be ok. In Break a Leg Take 2, I describe my experience having the entire process redone seven months after the original break.

France

We were in France after my second/third femur surgery and I was easily able to find a physical therapist who charged 25E per visit. During the same stay in France, Mike needed refills on a few prescriptions so using the resources provided by GeoBlue our insurance carrier, we located a doctor. The fee for the visit was $75 and Mike left the office with all of his usual prescriptions. The process was very easy.

The Not So Good Stuff

The surgeon in South Africa didn’t do a very good job repairing my broken femur. It became evident months later that the bone wasn’t healing and the pin used to hold the bones in place was working its way out. I don’t necessarily blame foreign medical care but the surgeon should have been a little more diligent and thorough.

What types of care have you needed when traveling?