Twenty-three hours. That’s how long it was going to take us to get back home from Egypt. The journey would involve four airplanes: Aswan to Cairo, Cairo to Paris, Paris to New York, New York to Los Angeles. Plus one 45-minute Uber ride to get to our front door. This was the calculation I was running in my head when trying to decide what to do about the blood clot I was convinced was in my leg.
I’ll admit: Too much reading on random medical websites got me to this panicked line of thinking. I laid in the bed at our hotel in Aswan, clutching my phone close while reading through symptoms of blood clots.
“Let’s go check out the pool,” my husband, Greg, said gleefully, hoping to do something fun on our last day in Aswan.
“In a minute. I’m just wrapping something up!” I proclaimed, before feverishly returning to my Google search results.
Have you been inactive for hours upon end? Yes. Three planes to get to Egypt, frequent naps in the hotel to overcome jet lag, a ferry boat Nile River cruise, a 3-hour car ride each way to visit the breathtaking temple of Abu Simbel on the border of Sudan…
Are you experiencing lower leg cramps, which can closely resemble a charley horse? Check.
Do you have swelling in your leg? Check.
Egypt was a bucket list trip for me and something that I had been looking forward to for quite a while. In the year prior, I had been through the ringer. A freak accident left me with three fractures on the right side of my hip that fortunately resolved themselves after 13 months of a grueling physical therapy routine. But our trip was booked and I was determined to be ready for it.
On our first day in Egypt, I hiked up the exterior of the Great Pyramid. I made it up the intensely steep staircase inside to the center, which I had been training for for months. I squeezed my legs tightly around a camel named Peetre, doing my best to cling on as he bounded down dunes of sand before flopping down in front of the pyramids where I treated him to a nice meal of leafy greens.
When I returned back to the hotel we were staying at in Cairo that evening, I fell into bed with an unwavering satisfaction. “I did it!” I exclaimed to my half-asleep husband. My body was officially back in business, it seemed.
Our next adventure was a Nile River cruise. But as it went on, I noticed that my left calf was getting progressively more sore.
The pain worsened every day, and it wasn’t long before I found myself wincing with every step up the long staircase between our boat’s dining room and our bedroom on board. After arriving at our last stop of Aswan, my calf was tender to the touch, swollen, and the pain had radiated up my whole leg.
When my husband was a child, his father died suddenly from a blood clot, so that’s always been in the back of my head. You’ve probably heard or read the recommendation to get up and move around on long flights when you can, and I’m typically pretty good at doing this. But I was trapped in the middle seat with a passenger who rarely got up on my longest of three flights on the way to the Middle East and had thus been too lazy to follow my typical routine. So when the pain arose, I was completely convinced that I had developed a blood clot and it had only worsened as we went along.
At this point, we were in Aswan, which is a city about 540 miles south of Cairo on the Nile River but seemed to me a bit less bustling than the capital city of Cairo. I was completely unfamiliar with the area and had no idea where the nearest hospital was, but I knew that I needed to be seen sooner than I could physically get home. I went down to the lobby of the hotel and asked if they had a doctor on site. They did, but he wouldn’t be available until the following evening. The hotel staff recommended that I visit a local German hospital, and said I could get there in a cab. The hospital wasn’t presently open but would reopen in the morning. So we set our alarms for 5 a.m. the next day, got up, and hailed a cab.
Once we spotted the hospital’s red cross sign, I approached the check-in window. But I wasn’t prepared with much Arabic, so it was tricky for me to convey what was wrong with me to the staff at the counter. He asked me to pay a small admittance fee before handing me a piece of paper with Arabic writing on it and motioning for me to sit in the waiting area.
When it was my turn to be seen, a nurse directed me to a station, where I hopped onto a scale. The next steps were typical of a visit to the doctor: I got my temperature taken, gave a urine sample, etc. Slowly, I began to get better at acting things out. Although I didn’t speak the language, it was amazing to witness our ability to communicate in other ways. I tried my best to say shukran (thank you) as often as possible. Though the staff giggled at my terrible accent, everyone seemed to appreciate the effort. I wanted to be as respectful—as “good” of a tourist—as I possibly could be.
A nurse brought me in to see an English-speaking German doctor who did an ultrasound and determined that I did not in fact have a blood clot. The verdict was that I had pulled a muscle, possibly due to the way I had been favoring my left leg for the duration of the trip by leading with my left foot. (I now babied the right side of my body after sustaining my hip injury a year back.) He gave me the all-clear and wrote me a script for an anti-inflammatory medication, should I need it.
Thankfully, I wasn’t dealing with any severe health issues. But the situation was admittedly stressful. I was in pain and in a foreign country. I had no idea how things would work in terms of insurance and payments; I just knew I needed my leg looked at. I didn’t speak the local language. In hindsight, I should have been better prepared.
If you ask around, lots of people seem to have some sort of story about a friend of a friend or a family member ending up in a hospital away from home—after twisting their ankle on a cobblestone street, a bad case of food poisoning, or maybe having an unexpected accident somewhere unfamiliar.
So what should you do if you find yourself needing to check into the ER while in another country? This is the expert preparation advice I wish I had considered ahead of my injury and hospital visit abroad.
1. Your health care experience might feel familiar and unfamiliar all at once.
Even though my visit to the hospital was initially jarring—I was worried about my health, feeling pressed for time, the environment was totally new, and I couldn’t communicate how I was feeling—I received the care I needed, and it felt relatively familiar to what I go through at the doctor at home. Of course, I can only speak for myself and about my experience in Aswan, in my specific circumstances. And it’s also important to acknowledge that not only is every country and specific city/region different, but sometimes as tourists, we have access to facilities and resources that not everyone in that particular location may have (including the locals).
In fact, my experience in Aswan was essentially just like any other doctor’s appointment I’ve ever had. For example, I went to the hospital, did my best to explain what was wrong, got diagnostic imaging, was assured it was nothing serious, and was sent home with a prescription should I have needed it. This pretty much describes what would’ve happened if I’d gone to the ER back home in Los Angeles. But of course it felt very different, as do so many things when we’re traveling to a place that’s foreign to us. The first (and maybe best) piece of advice I can give from my experience is to be prepared to experience something unfamiliar while knowing that just because it’s unfamiliar to you doesn’t mean that you won’t get the medical care, attention, or and treatment you need.
“It varies very much from country to country, but generally speaking, one should keep in mind that the local providers may have a different cultural background, the environment may be different [from] what we’re used to at home, there may be a language barrier—but you won’t be sacrificing quality of treatment and service to the patient,” Katelyn O’Shaughnessy, CEO and founder of DocTours, which connects patients with doctors and clinics abroad for medical procedures, tells SELF.
Ultimately, you may be tempted to wait until you get home for a variety of personal reasons and conveniences—you feel really comfortable with your regular doctor, or you’re nervous about miscommunication because you aren’t well-versed in the local language, perhaps. But you should keep in mind that whether you’re near health care you’re used to or not, delaying treatment for something serious could be dangerous. “An open mind is a must,” O’Shaughnessy says.
2. Map out where health centers are located ahead of time.
Research the local medical care options in the region you are traveling to prior to arrival, Cwanza Pinckney, M.D., an emergency medicine physician in Houston, tells SELF. That means knowing where the nearest health center is to the sites you’ll be seeing and places you’ll be staying, and reading any reviews or patient experiences online if you can find any.
Then, it’s worth going as far as putting all of this information—including telephone numbers and the address—in your phone for easy access. You may also want to take screenshots of a map with a pin of the health center location on your phone for when you may not have access to WiFi.
Another tip: If it’s possible in your specific location, consider locating and seeking medical attention at a university hospital, where you may be more likely to find internationally trained (and English-speaking, if that’s preferable for you) physicians, emergency medicine physician Frank Illuzzi, M.D., who is the chief medical officer at CityMD, tells SELF.
3. If you have insurance, talk to your provider in advance.
Dr. Pinckney also recommends reaching out to your insurance company and telling them that you will be traveling abroad, in addition to asking them what kind of coverage they offer internationally.
Also, do your best to “keep track of your care” during your hospital visit or stay, Dr. Pinckney says. For example, she stresses the importance of making sure that you or a companion obtain a list defining what treatments were performed, any supplies that were utilized, as well as the costs needed to care for you during the duration of your stay at the hospital. “In receiving a record of these items, you can prevent further charges from being administered in the future and provide these costs to your insurer for reimbursement if you are in fact covered across borders,” she explains.
However, many domestic health insurance plans don’t cover you abroad, so you may want to look into getting travel insurance before your trip. “Travel medical coverage pays for hospital and medical expenses due to an unforeseen injury or illness while traveling,” Stan Sandberg, an agent with TravelInsurance.com, tells SELF. He adds that typical travel insurance coverage pays for ambulance service, treatment by doctors and nurses, and most hospital costs. “This includes surgery, medical tests, anesthesia, and prescription drugs,” Sandberg continues. “Emergency medical coverage may also cover sudden dental emergencies, such as a lost filling or a broken tooth.”
Daniel Durazo, director of communications for Allianz Global Assistance USA (another travel insurance company), tells SELF that you should hold onto any receipts for out of pocket payments, which you will use to file a claim with the company upon your return. “For a customer who is admitted overnight for medical care … your insurance company handles all the billing directly with the hospital. If you are just receiving minor medical treatment, like at a clinic, you would pay upfront and then submit your expenses with documentation of your visit for reimbursement,” Durazo explains.
4. Keep your personal information and documents somewhere safe and convenient.
Robert L. Quigley, M.D., senior vice president and regional medical director of the Americas region at the medical and travel security services firm International SOS, tells SELF that having the following information written down and on you (meaning in whatever bag you’re carrying with you throughout the day) at all times during your visit abroad:
- A note card with the name, phone number, and email address of your primary care physician and/or travel doctor
- A note card with a list of allergies and any current or chronic illnesses
- The address and phone number of a hospital or clinic you identified ahead of time that is within the vicinity of your travel destination
- A written list or printed forms stating your previous medical history, including things like past surgeries
- An emergency contact person or list
- Prescriptions for each medication you are taking
In regards to prescriptions, Dr. Illuzzi emphasizes the importance of having a copy of your medications and their generic names, as well as the doses you take (including the dosage in milligrams, for instance, don’t jot down just “one pill”).
When entering a foreign country, it’s also a good idea to have a piece of paper with you that has local phrases to refer to in case of an emergency. For example, you can benefit greatly from being able to communicate to a cab driver that you need to be taken to the nearest hospital. “Any pocket travel dictionary [or] guidebook usually has a section on navigating a health-care encounter,” Dr. Illuzzi says.
5. Make hospital communication as clear as possible.
Dr. Pinckney suggests bringing an interpreter who speaks the local language to accompany you to the ER if you can. For instance, if you have a friend that you’re visiting, Airbnb host, or perhaps a friend of a friend who speaks your language as well as the local language, they are good people to ask for help. Or, if you’re staying at a hotel, you can ask the concierge if they have someone available or inform the hospital front desk that you need assistance with language translation. You can also contact the International Medical Interpreters Association for assistance in locating one.
If these are not possibilities, be prepared to use a translator tool, Caitlin Donovan, director of outreach and public affairs for the National Patient Advocate Foundation, tells SELF. “You definitely don’t want any miscommunication during a medical emergency,” Donovan says. “If you’re not fluent and don’t have a human translator handy, use an app to ensure that you and your medical team understand each other.” Google Translator is a good option, she says.
6. Study up on the place you’re visiting to help avoid a health issue.
Dr. Illuzzi prepares using a few websites prior to any travel: “Before traveling I visit CDC.gov, which has a section on Traveler’s Health,” he says. “It will let you know if there are any health advisories or outbreaks in that country—such as Zika, malaria, or Ebola outbreaks.” The site will even tell you if there is a seasonal illness, such as the flu or a heat wave, that you should be aware of and a list of any recommended vaccines to get prior to arrival, he adds.
Dr. Illuzzi also recommends keeping tabs on travel.state.gov, which has a tab for international travel and will give you an overview of the country, including any advisories, political situations, as well as a list of major hospitals, English-speaking doctors, and instructions for how to alert the local U.S. embassy of your arrival.