Health Away from Home

Health Care Over There

By Caroline Grannan


Travelers often don't give much advance thought to the possibility of a health crisis in a foreign country. Whether they should depends a lot on where they're going. International tourism exposes the traveler to a wide variety of health risks, medical systems and possible insurance snarls. Insurance and medical advisers urge travelers to prepare themselves.
Health care over there        "Know your blood type, any allergies to medications and, if you have a condition, the status of your condition," says John Nelson, a trustee of the American Medical Association (AMA) and a physician in Salt Lake City. "Consult your doctor about whether you have any condition that will be threatened by the proposed travel. If you use a prescription medication, take it correctly labeled and carry it on, rather than checking it with your baggage."
      And, Dr. Nelson adds, be aware that health care varies. "Being sick in the United Kingdom, Mexico, France, Italy or Spain is a whole different ball of wax from being sick in Guatemala, Nigeria or parts of South America."


Are You Covered?

      Finding out if insurance covers foreign medical care is a vital step. One important caution: Medicare does not cover health treatment outside the United States. Many "medigap" plans do, aswell as some other health plans by covering   emergency treatment and "urgent care" only.
      "Before you go, talk with your employee-benefits manager or insurer, urges Richard Coorsh, spokesman for the Health Insurance Industry of America. Many travelers also purchase "travel medical" and   "medevac" insurance which covers air-ambulance service -- something that can run as high as $100,000 for evacuation from far-flung parts of the world. Information on medevac services and insurers is available on the U.S. State Department's Web site


Where to Turn

      If it's feasible, the standard advice is to call the nearest U.S. Embassy for a referral to an English-speaking physician. "We have no oversight of health facilities abroad," notes Roz Dewart, chief of the Travelers' Health Section for the national Centers for Disease Control and Prevention (CDC).
      "Our recommendation is to always contact the U.S. Embassy. They are there to assist U.S. citizens in an emergency," Dewart says.
      A nonprofit Canadian organization called the International Association for Medical Assistance to Travellers provides lists of English-speaking physicians worldwide to members, and also offers information on immunizations, climate and sanitation conditions, malaria risks and prevention, and other travelers' health concerns. Membership is free, though the group welcomes donations. To sign up, send your name and address via e-mail or access the group's Web site.
      Before embarking on a trip, it may be useful to check every nation on your itinerary through the U.S. State Department's Web site. The CDC also maintains worldwide information on its Web site, along with information on required and recommended vaccinations.


Exercise Common Sense

      Finding health care overseas can raise perplexing questions because of differences in treatments and drug availability. San Franciscan Margo Freistadt was visiting Israel in the late 1970s when she ran out of medication she'd been using since childhood to ease symptoms of a chronic infection around her eye. An Israeli doctor gave her a different drug for it and the infection -- which U.S. doctors had told her would plague her all her life -- vanished permanently, without side effects. "When I got back to the United States, I asked my doctor, and he said the medication that cured the infection can also blind you," Freistadt says.
      Twenty years later, it's impossible to confirm the details of Freistadt's account, but it's an example of the kind of situation that can confront travelers. They're also likely to find that drugs requiring prescriptions in the United States are readily available over the counter elsewhere, posing the temptation to self-treat.
      "Use common sense," the AMA's Dr. Nelson cautions. "There are reasons that these drugs are available by prescription only."
He especially warns against "willy-nilly" use of antibiotics that can be purchased over the counter in some countries, because of the danger of increasing disease-causing bacteria's resistance to the drugs.
      "You might have access to things you won't have here," agrees Arthur Allen, a San Francisco ophthalmologist. "Cultures are different, and economics are different. After all, you can buy heroin legally in some places."
      Allen adds, "Don't forget that there are phones in every country. The first thing to do is call your primary-care physician. As they said in "E.T.": 'Phone home.' "


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