If you follow our blog, you know I had the fortune to visit the Emergency Room in El Salvador recently. Fortune I say, because the life lesson learned ended up more profoundly impactful than any anxiety to visit an ER abroad. Vulernability, our willingness to collapse into our shared humanity with anyone willing to shoulder our troubles with us, is what got me through the experience.

Format Emergency Room by Thierry Geoffroy, February/March 2007.

But poetic life lessons aside, there are very practical things to consider if you’re abroad and in need of a visit to the doctor. What do you do? Where do you begin? How does insurance work? This guide is by no means exhaustive, but it is built on first hand experience having been to the ER myself or with others in multiple countries now. Lucky me, I know. So what should you consider when visiting the ER abroad?

Be proactive, have insurance

Regular health care is a great start. But make sure it includes coverage abroad, including emergency air evacuation. If it doesn’t have that, splurge and get some travel insurance that does. It will cost you a few bucks but save several thousand and quite possibly your life if the worst of the worst happens and you find yourself in need of it.

Priority one is your health
Sounds obvious, but you’d be amazed how it’s anything but. Your mind will race with thoughts from “how the hell will insurance work here?” to “how should I choose a hospital?” If you have the luxury to investigate this beforehand, great! If not, here is what you need to do: Talk to someone you think you can trust, be it a friend familiar with the country, or the hotel front desk, and tell them you need to get to a hospital. If you’re really scared, ask if anyone can help you. A friend once got sick abroad, and was cared for through the process not only by competent doctors, but a hostel employee who refused to let her navigate healthcare in a foreign country alone.

Research Before Your Trip
I always try and consult the U.S embassy website for your specific country which almost always provides a guide to hospitals, dentists, and more. Print it out, bring it with you, you won’t regret it. If you didn’t print it, not to fear, just Google “United States Embassy (whatever country) doctors” and hopefully it will be one of the first pages.

Know your insurance plan in advance

I knew my insurance would be handled on the backside. This made my life a bit easier as I wasn’t too concerned about what the cost was going to look like. I was always struggling to breathe, worried that my struggle to breathe might turn into not breathing. Moments like that, you don’t really give a crap about how much it will cost, but rather that mere money can actually take care of you. So keep that in mind, take care of yourself, figure out the price later. But knowing what insurance covers is great. Also knowing what things cost as options are presented to you is smart. I want to believe all hospitals ethical, but personal experience with a corrupt doctor in the USA long ago taught me otherwise. Similar to eating at a restaurant, know the price of what you’re getting, before you get it. “How much will that cost specifically?” was something I asked on everything from the initial entry to the hospital to the blood work, to the x-ray, and so on.

The true cost of healthcare in other countries
Finally, rejoice and be glad, not everyone has prices like countries many of you are reading this from. I saw thousands of dollars of expenses being fronted by me, and nightmares of battling with insurance adjustors. Instead, I paid $127 out of pocket for admittance to the hospital, a consultation with an ER doctor, a pulmonologist, an x-ray of my chest, blood work, and multiple treatments on a nebulizer.

Be discerning, but also trust in your medical team
When I returned back to the guest house I was staying at after my scare, one colleague of mine couldn’t wait to tell me how woefully undertrained doctors in El Salvador are in his opinion. When I told him the medicine prescribed he quickly and confidently proclaimed “Oh my God, they prescribed you double the steroids they should have.” Why I chose to even believe him who knows, but a quick text to my sister-in-law, a nurse, and two friends who were doctors provided comfort: “That’s exactly what I would have prescribed” they all said.

And so a healthy dose of skepticism is good in your health care, but don’t forget, if you’re reading this it probably means you’re not a doctor. Nonetheless I was observant of everything. When they came to take my blood, I inspected the needle and asked why it was necessary to take blood. I weighed each element of my treatment with the attention it deserved. But I also had to put a certain amount of trust in my medical team. Do the same.

Get the name of the prescription in English
I speak Spanish well enough to more or less get the idea of everything that was happening to me. Some talk was over my head, but that happens in English when my doctor rambles out words I am sure are almost exclusively meant to be used in MCAT settings and weird doctor cocktail hours- certainly not with concerned patients who just want to know basic things like “Will I live?” or “How bad will this hurt?” But one thing I was adamant on was this: I needed to understand as much as I humanely could. No pretending to understand and nodding while saying with introspection “oh, si.” If I didn’t understand what the doctor was saying, friends either translated or I did my best to ask what he was saying through other means until I understood. I also got the name of my medicine in English, so I could Google it back in my hotel and read more instructions and precautions while taking it.

Save every receipt and prescription

You will need that when you begin to battle with your insurance. It’s almost as fun as what got you placed in the ER in the first place but hey, at least you’re still around to tell the automated machine “operator” over and over praying a real human can get on the phone to shoot your dreams of quick resolution to your settlement. Too dark?

Set up an appointment for your return to the USA

“Hey doc, just got to visit some of your homies in El Salvador. The ER wasn’t my favorite site along the tourist track, but it did the job. Any chance we can get together just to make sure you know what’s up and so we can make sure you think I am good moving forward? I don’t think my doctor was amused, his email response didn’t address his colleagues as homies, but he did grant me my wish for an appointment.

Be thankful

I was so grateful to so many people each time I have had to visit an emergency room abroad (yes, it’s happened more than once). The friends who helped me get there and/or translate. The doctors and nurses who treated me with kindness and wisdom. So thank people and if you’re a fan/believer in higher powers, give a shout out when you’re able to rejoin them, break bread, and laugh about the moments that weren’t so funny while you were in the hospital.

Photo credit: Joaquin Loustau

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