Replies: 8 - Last Post: Apr 9, 2013 5:04 PM Last Post By: llaparanger
Oct 22, 2012 3:38 PM
Travel-Health InsuranceWe recently returned from five weeks in Tanzania. While we were there, my wife got quite ill while we were up in the Usambara Mountain area. The diarrhea had been going on for several days, but then her fever started up. As a precaution, we had brought a supply of Ciprofloxacin. What we didn't know was when and if we should start the medicine and how long we should continue it. Cipro is an extremely strong antibiotic, and should not be taken unless you really need it. Luckily, we had an annual membership with Global Rescue, a company that provides emergency medical evaculation. This company also provides a direct link with Johns Hopkins Hospital in Baltimore, Maryland. We didn't bring a phone, but we did bring an iPad. I sent an email to Global Rescue describing our problem. Within a few minutes, I got a reply asking for more detail. I provided information on my wife's temperature and on how bad her stomach was. In less than an hour, an email from a doctor at the hospital was patched through Global Rescue telling us to start the Cipro immediately and continue it for three days. We were also told to continue the anti-diarrheal medicine. We might have done more or less the right thing without Global Rescue, but it was comforting to know that we were doing what was recommended by a doctor. My wife's fever broke the next day, and we continued our vacation. Also, on that same trip, I requested and received information from Global Rescue on the effects of Lariam (anti-malarial) on dehydration.
I am anything but a spokeman for this company. Still, I think it is important for world adventure travelers to know how important such insurance can be. Several years earlier, my brother fell out of a tree in the Central African Republic. He broke his back when he hit the ground. The doctors in Nairobi, where he was transported, wanted to operate. He simply did not trust their decision or their ability. An emergency evacuation company was contacted to provide transport back to the US. Upon checking into the hospital in Miami, my brother was told that an operation was not needed. His back was immobilized for two months, and he healed completely without the operation. The cost of the evacuation from Africa to the US was $160,000. The good news is that his medical insurance company paid the full price. This is definitely not normal. My brother should have been stuck with the full bill. Since his accident, my wife and I have maintained an annual membership with Global Rescue. Many other evacuation insurance companies will only pick you up in major cities. Global Rescue provides choppers to get you in from the bush, and then transports you back home. I may be wrong, but I think this company is the only one that provides medical advice that might just keep you from having to be rescued. If you don't mind being operated on in the third world or don't mind paying over $100,000 dollars to get home after an accident, I would ignore this message. This is not insurance that pays for your flights in case of a problem. This is medical and financial survival. I strongly advise getting some type of emergency evacuation insurance from someone, if not this company.
Oct 23, 2012 11:22 AM
1Personally, I'd have checked cipro dosage on line and skipped all the intermediaries. Medivac insurance may be worth having (I sometimes buy it, sometimes don't), but not for the situation you're describing in Tanzania.
Oct 23, 2012 1:30 PM
2The dosage was on the bottle. That wasn't the question. The question was whether my wife's condition was bad enough to require Cipro and how long to take it. If you take this kind of medicine each time you have some malady, it won't work when you really need it.
I went years without evacuation insurance myself. In reality, it's not likely that you will ever need it. My company started buying it for me when I went to Russia and China for meetings. Then my brother fell out of a tree in Africa. That was my wake up call. I'm at that point in life where I could probably afford to pay for the evacuation myself, but it would come close to wiping me out. My wife and I are spending about two months each year traveling to places all over the world. A family annual membership for such insurance makes me sleep better. If you trip on the curb in Cairo and break you hip, what are you going to do? Commerical airlines are not going to let you on the plane if you can't walk or sit up. Are you going to stay there for two months and trust them for proper care? Maybe. I'd rather go home.
Oct 23, 2012 2:24 PM
3"If you take this kind of medicine each time you have some malady, it won't work when you really need it."
Actually, that's not true--it's not the way tolerance works and it's not the way resistance develops. However, it's true that if lots and lots of people take cipro "each time," resistant bacteria will certainly evolve, rendering the drug less effective. That's different.
It's also true that fluroquinolones like ciprofloxacin have been implicated in sudden tendon failures--a resoundingly unpleasant possibility. For this reason alone I'd be reluctant to take cipro "each time."
I'm not arguing with your stated belief that everyone should carry medivac insurance. That's your belief, and that's fine. I'm trying to suggest that a Johns Hopkins consult needn't be a prerequisite for proper treatment of someone who is taken "quite ill." Based on my own experience, I'd also suggest that not only antibiotics but also antiparasitic medications be carried and, when appropriate, used.
Oct 23, 2012 2:50 PM
4Mark, sounds like good advice to me. I've never carried antiparasitic medication. What is it? I was a medic in Vietnam, but I was mainly trained to stop bleeding.
Oct 23, 2012 3:10 PM
5I carry metronidazole routinely, and I use it at least as often as I use antibiotics--against giardia and suspected dysentery, both of which I self-diagnose. Some recommend tinidazole instead these days. I also carry two different anti-malarials--one to take as a preventative, one for emergency cures. I haven't had acute malaria since I switched to Malarone from mefloquine eight or ten years ago. I rotate my supplies of these and other medications to try and keep them reasonably fresh. I seldom actually take them, but when the time comes I don't hesitate.
I've had poor luck relying on diagnosis by Western medical professionals on all three of these diseases--too much reliance on the availability of reliable blood and stool tests.
You'll note that I'm not giving medical advice here, and that I've had no medical training past Wilderness First Aid. I do try to stay awake and pay attention.
Oct 23, 2012 3:32 PM
6We have been using mefloquine for our last three trips to countries where malaria is a problem. No problems yet. I have had some very interesting dreams with that medicine, but haven't killed myself or anyone else yet. Seemed like a waste for Tanzania, at least for the time when we were there. I don't think either one of us was bitten by a mosquito even once. I don't remember what we used in Vietnam. There was a daily pill and a weekly pill. It was my job as the medic to pass them out. We still had people come down with malaria. I got it after I came home, but that was only because the hospital that treated me for wounds forgot to continue the treatment for three weeks afterwards.
Recently, my wife was treated for giardia after we returned from Peru. She was given Cipro. I'm mostly guessing, but I think the diagnosis and the form of treatment was wrong.
Oct 28, 2012 12:42 PM
7I'm with you rion99. I would never travel without emergency medical and emergency medical evacuation insurance - I usually get 500K in coverage. It is not that expensive. I was recently in Myanmar and knowing I could get airlifted to Bangkok if necessary was a great comfort. That goes for many other places we have traveled in SEA and south Asia where top notch health care is limited to a few major cities, Australia, Hong Kong, or back home to USA. I'll be looking into Global Rescue too. We have been places where a helicopter would have been necessary to get us to an airstrip/airport. A helicopter could mean the difference between life and death.
Apr 9, 2013 4:51 PM
8Just a point regarding taking Cipro. It does not cause problems with tendons in adults. The warning is for children because of studies that were done with beagle puppies. There has since been more widespread use of the medicine in children and is now proven safe. I'm not advocating taking antibiotics when you don't need to, but you should take Cipro at the first sign of diarrhea in a developing country.
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