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Adventure Magazine

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Harsh Medicine
An accident overseas can ruin your vacation, health, and savings—unless you're prepared. By Robert Young Pelton

Illustration: falling rocks!

A few years ago, while I was riding a motorcycle in Peru, a sedan came barreling toward me on the wrong side of a twisty mountain road. I swerved, heard metal and bones crunching, then flew topsy-turvy through the air. I laughed at my good fortune—at least I was still alive. The bad news was that I had a shattered wrist and crushed leg and I needed medical treatment, fast.

Fortunately there was a dilapidated and foul-smelling hospital nearby with an English-speaking gynecologist who insisted that he could reset my broken bones. I woke up from a not quite heavy enough dose of sodium Pentothal to find my right arm and right leg enclosed in massive casts—but, hey, the whole medical bill was less than $250. Back home in L.A., a specialist looked at my X-rays with horror and immediately sent me in for surgery. Eight hours and $14,000 later, I had a Darth Vader-worthy titanium-packed wrist and a reminder of the cost-to-value ratio of Third World medicine: Spend a little extra before you go—or be ready to pay the price.

PACK YOUR MEDICAL KIT. After arranging vaccinations and malaria meds, here's what I bring along regardless of destination: a 20-day supply of prescription antibiotics such as Cipro (to handle internal strife like dysentery) and Augmentin (for external affairs such as ear and skin infections); a big tube of antibiotic ointment like Neosporin for minor scrapes and cuts; acetaminophen or ibuprofen, for when you haven't got time for the pain; a basic first-aid kit for wound management; an antidiarrheal like Imodium, to be used sparingly; and tissue-adhesive glue such as Indermil, which is like stitches for superficial but potentially nasty wounds, but without the pesky needle and thread.

BUY A BACKUP PLAN. What should I have done differently in Peru? Well, I should've bought travel and medical-evacuation insurance before going. Serious treatment comes at serious prices. Kenneth Kreye, M.D., medical director of Air MD, an air ambulance service, estimates that an emergency evac from a remote foreign location to a major U.S. hospital can cost between $15,000 and $100,000. His advice? "Buy short-term travel and evacuation insurance, tell them what activities you'll be involved in, and check the upper insurance limits of the policy." If misfortune befalls you, your provider should immediately contact area doctors and get you to the most efficient medical center. Adventure travelers can buy per-trip insurance for as little as $3.50 to $5 a day.

PREPARE FOR THE WORST. You'll survive hangovers, sunburn, and gastric distress. Your biggest concern for life and limb are traffic accidents, often (like me) on rented scooters and motorbikes. Anything worthy of an ER trip in the U.S.—bad fractures, serious infections, internal injuries, and life-threatening cuts, falls, or trauma—will merit a plane ride out of a developing country. A nasty spill in Nepal might get you flown to Bombay; a bus crash in Uzbekistan could land you in Istanbul. At some point the insurer will want to get you home to convalesce, so have trip-cancellation insurance rolled into your medical coverage. Had I paid the 30 bucks for coverage in Peru, I would have received the best health care, and spent next to nothing.

LAST RESORT: GO LOCAL. You screwed up like me and didn't arrange travel insurance? U.S., Canadian, U.K., or Australian embassies will have a list of English-speaking doctors and good hospitals. Socialized medicine can be a real boon to the frugal but sick traveler; services are often cheap. But since you're a foreigner you'll often need to pay cash, usually in advance, and many times your regular insurance won't pay for unauthorized treatment outside North America. Even if they do, don't expect much joy in translating your Bengali bill to a customer-service rep back home.

Ask Pelton: Do you have a burning travel question that only the world's most dangerous writer Robert Young Pelton can answer? Send us your question by e-mailing adventure@ngs.org, subject line: Ask Pelton. The answer could appear in an upcoming column.

Additional Excerpts
From the print edition, August 2004

Wild Roads Special: The Best of the Backcountry
Stomping Grounds: The clash of man and elephant in northeast India
The Vanishing World of Lonnie Thompson: How glacial ice cores are unlocking the mysteries of global warming
Pelton's World: Dealing with a medical emergency overseas

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More from writer Robert Young Pelton

Afghanistan's Shadowlands
Pelton's photographs of Afghanistan reveal the dangers facing coalition forces and the hopes of a battered nation.

Q&A: Grabbed in the Gap
Robert Young Pelton literally wrote the book on traveling in dangerous places. Good thing: All that hard-won experience came in handy when he was abducted while hiking Panama's Darién Gap.

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August 2004

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