Reflections

Blood Tests, Birth Control, and Motorbike Accidents: My Experience with Healthcare Abroad

June 4, 2017

I’ve learned a lot over these past 20 months of travel (man, has it been that long?) and one of those things is that getting medical care abroad is totally not a big deal. Turns out, it’s actually way easier than getting it at home! This post is a bit of an informative letter to my past self… and anyone else thinking about leaving the U.S. for an extended period of time.

It’s also for anyone curious about how healthcare abroad has been working out for me.

Worries About Healthcare and Long-Term Travel

I’d like to write the post I wish I’d read before leaving home. A post to let anyone (especially folks from the States) know what it’s like to be on the road and need healthcare or prescription meds, and how I handled it. The good news is that so far, it’s been way better – as in, more efficient and cheaper – than being at home. For me, at least.

After I quit my job to travel, I was left health insurance-less. Like pretty much instantly. (Well, I opted for one month of COBRA so that I didn’t have to pay the penalty for being uninsured, and uh, it was like $400.) But I will admit, I felt a bit vulnerable without it. Welcome to the lives of millions of Americans, I guess!

However, I’ll go ahead and throw it out there that I’m privileged and grateful to be a healthy human being with the use of all of my limbs and no health issues – knock on wood! I’m so lucky enough to be able to travel the world without any lingering health concerns. So I relinquished my job and it’s accompanying health insurance safety net and headed out into the world to just figure it out in other countries.

*Obvious Disclaimer: I am NOT a doctor.

Let’s start with the easiest first.

Healthcare Abroad Long-Term Travel - Trailing Rachel

Birth Control Abroad

Before leaving North Carolina, I Google’d my specific birth control prescription to see if I’d be able to find it in South America. Like just reading that sentence now makes me feel like a crazy person. It was very unnecessary.

In the beginning I was worried about being able to find birth control pills abroad, and I didn’t really want to stop taking them. Considering the U.S. requirement for an annual visit to the gyno, a prescription, and a visit to the pharmacy, I didn’t know what hoops I’d have to jump through while abroad.

Um well, none, as it turns out.

I have yet to have a problem buying birth control pills OVER THE COUNTER in any country. From South America to Southeast Asia to Europe, no pharmacist has ever told me I needed a prescription or a trip to the doctor. (Mind you, this is only in the countries where I’ve tried to purchase them.)

And yes, I understand that an annual trip to the gyno is good for one’s physical health and diagnosing possible cervical cancer, but in the meantime, why would you want a woman to go without birth control if she didn’t have access to a doctor or couldn’t afford the check-up? (“Ahh well, fuck her, we’ll just risk her getting pregnant AND not having health insurance to cover that.” – The United States, apparently.)

But the best thing about OTC birth control in other countries? It’s incredibly affordable and accessible. At home, my generic pills were covered by health insurance that I had through my job (well, for a month at a time anyway *eye roll*). But when I had to buy extra packs for travel, they were $20 per month. Good thing I take the generic stuff.

But you know what? It’s cheaper than that almost everywhere else…  like way cheaper.

If you’d like me to be specific about countries and costs, just in case you’re planning a trip (or you’re nosy), I was able to purchase birth control pills over the counter in all of these countries:

Colombia: $7

Ecuador: $3.50

Thailand: $1 (Yes, literally $1 per month)

Vietnam: $1.50

Indonesia: $1.13

Spain: $27 (the highest, but still over the counter, so I can’t complain)

Bulgaria (did not purchase, just wanted to know they had it)

Nepal: $1.50 (and they came with iron supplements for the week you start your period, because most women there don’t eat red meat – genius!)

Lots of these pills are brands made by reputable companies are like Bayer and Pfizer.

What about the language barrier with the pharmacist? Easy. Just bring in your old packet of pills so the pharmacist can figure out exactly what you want. Done and done. (And maybe stock up so you don’t have to buy them back in the States when you don’t have health insurance. *points to self*)

Healthcare Abroad Long-Term Travel - Trailing Rachel

Getting Dengue Fever and Blood Tests in Thailand and Vietnam

Do I need to relive this experience for you? Read the full story here and here.

After feeling like death for days and deciding that something was wrong with me other than the flu, I paid a visit to a clinic on the island of Koh Tao in Thailand. I had a consultation with an English speaking doctor and blood work was sent off. She called me back with results that evening, had me come in to chat, and explained the next steps to recovery, which involved repeatedly checking my platelet count over the following days.

Total cost of this experience? $16.79 USD (or 600 baht)

Oh, but I was off to Vietnam in the next couple days. Did I really have to get repeated full blood counts taken there too? Yes, because this is your life, Rachel.

Following a visit to a large medical lab/clinic in Hanoi and zero waiting time (along with some miming on my part), the staff filled a tiny vial with my blood, labeled it with a barcode, and handed me a sheet of paper with a password and the website where I could check my results. They’d be available, oh… that afternoon! Amazing.

Cost of a full blood count? $4.48 USD (100,000 dong)

But of course, I was not yet well and I had to go back two days later to make sure my platelet count was up. The cost of that second full blood count? $4.25 (95,000 dong). Why was it cheaper this time? They gave me a discount for being a repeat customer!!!

My mom (who is a nurse and was probably terribly worried about me at this time) said that a full blood count at home would have easily cost me $100…

Healthcare Abroad Long-Term Travel - Trailing Rachel

Jellyfish Larva Stings On My Butt in Malaysia

Okay, so this was minor, but it was easily THE itchiest thing I’d ever experienced. While swimming, it seems the larva congregated in my bathing suit and left their little barbs in me in an attempt to ruin my life (apparently it’s common in the Perhentian Islands). On a tip from my new German friend, I invested in some Calamine-like lotion from the local pharmacy and a ten-pack of antihistamine pills.

Total cost? $2.20 (9 ringgit).

Result? Immediate relief.

Healthcare Abroad Long-Term Travel - Trailing Rachel

Motorbike Accident in Bali… and a Subsequent Infection

Well this was stupid.

I can’t drive a motorbike. And not so surprisingly, even after my 30-second ride and resulting crash, I still can’t drive one. (FYI, I blame Marko.* One should never try to drive for the first time with someone on the back.)

Well, I scraped up my ankle pretty bad – and despite our attempts to wash, disinfect, and cover it with Neosporin, it still got infected. How did I know it was infected? Because Google reported all of the following as signs of infection:

Red, painful, swollen, hot to the touch. Yep, I pretty much checked all the boxes.

I walked from the hostel to the pharmacy, showed the pharmacist, and she said, “Yep, it’s infected” and handed me three days worth of amoxicillin, gave me instructions for taking it, and suggested I let the wound breathe overnight. I paid at the cash register up front.

(Yes, I also understand that OTC antibiotics are not the best idea, and that they should be prescribed by a doctor so that they don’t contribute to supergerms, but damn if it’s not helpful to be able to go straight to a pharmacist who can identify what you need and sell it to you. They’re smart people too.)

I wanna say it was around $4.

*Marko totally can’t comprehend my healthcare rants, because he’s English and they have the NHS and their shit is free…

Healthcare Abroad Long-Term Travel - Trailing Rachel

A Chest X-Ray in Malaysia

Wait, what?

So when you’re applying for your New Zealand Working Holiday Visa and you’ve spent several months in countries that don’t have a low risk of TB, it turns out you’ll need a chest x-ray to enter the country. I’d been in Southeast Asia for much of the preceding year, so yep, I had to get a chest x-ray.

And you’ll need to get one sent to the NZ Immigration folks pretty soon after they receive your visa application.

I happened to be in Malaysia at the time.

Thank the Lord I didn’t apply for this visa while I was in the U.S.!!!

While I truly dreaded it, the whole process ended up being incredibly easy (with no appointment necessary). The health center that I visited in Kuala Lumpur was probably the nicest medical establishment I’ve ever set foot in. Not only was it sleek, clean, and modern, but there was little waiting time, they gave me a wristband and called my name as I moved from room to room to x-ray room, and then they handed me my results… within minutes. And they had e-medical capabilities, which means they were able to send the results of that chest x-ray directly to the New Zealand Immigration Office for me.

Total cost of a chest x-ray in Malaysia? $32 USD (145 ringgit)

This would have easily cost hundreds of dollars in the U.S.

Oh, and I had my visa back from New Zealand within three days.

Healthcare Abroad Long-Term Travel - Trailing Rachel

Going to the Dentist in Thailand

Sorry to every dentist friend I have reading this. I used to have money sucked out of my paycheck every month for dental insurance – like way more than needed to cover two cleanings/check-ups a year. In hindsight it was silly. And kind of a racket.

But I really did like my dentist. I just couldn’t afford him out of pocket when I got home from traveling.

And after a year and a half of travel, I kinda thought that yeah, I needed my teeth cleaned. (I’ve got those permanent retainers and well, they get a little gross.) I also needed to make sure I didn’t have cavities, obviously.

After doing a little research on dentist offices that the expats frequent in Chiang Mai, Thailand, I settled on one that looked legit. Marko went with me to get his teeth cleaned. (He’s British so he pretty much never goes to the dentist and he doesn’t floss, like ever. He actually admits to these things.)

Not only was the dentist office clean and filled with friendly staff, we were both able to get an appointment THAT DAY! (When does that ever happen at home?! I’ll tell you – it happens never.)

Cost of a dentist visit and cleaning? Get ready to fall down dead. $14 USD (500 baht)

And my retainers have never felt better.

Long Term Travel Abroad Healthcare - Trailing Rachel

Teeth still haven’t fallen out


I DO Have Travel Insurance!

I don’t wanna act all cavalier, like I’m going through this traveling-centric life just willy nilly without health insurance. If anything really bad were to happen and I had to go to the hospital while abroad, I’m covered by a policy with World Nomads. It also covers some dental, property, trip cancellation, and scary things like medical evacuation and repatriation of remains. Luckily I haven’t had to use it – as you can see, none of my medical costs have warranted claiming – but I’d recommend it to anyone thinking of traveling longterm, just for peace of mind.

But my travel insurance (like a lot of travel insurance companies out there) won’t cover me in the U.S.

Healthcare Abroad Long Term Travel - Trailing Rachel

What Else? No Worries? Really?

I actually do have lingering worries about my healthcare. But those worries center around being back home – sans health insurance – and getting sick or hurt. That’s right. I worry about my healthcare IN THE UNITED STATES more than I do literally anywhere else I’m traveling. It’s scary as hell to go without health insurance there, knowing that you probably can’t afford a trip to the doctor.

Like I have zero idea what a trip to the doctor even costs out of pocket! That’s the other scary thing about it in the States. You avoid going to the doctor for anything because nobody can tell you what it should or will cost.

Long Term Travel Abroad Healthcare - Trailing Rachel

How I’m gonna be all the time in the US

And I never would’ve known this precarious uninsured feeling if I hadn’t quit my job. So now I see everybody’s concerns. I see why affordable healthcare (or at least affordable health insurance for the love of God!) is necessary.

Because it seems like basic medicines, prescriptions, contraception, and doctor’s visits don’t actually cost that much. Or at least they don’t in other parts of the world. But for some reason at home, they do.

And don’t give me that “Because we’re better, it costs more.” The U.S. is ranked 37th on the World Health Organization’s list of efficiency for health systems performance. Like, just below Costa Rica. All those European countries are at the top. Hell, Colombia is 22nd. (I was directed to that stat by this amazing article on America.)

I get that the U.S. is probably the place to be if you have cancer or something complicated or mysterious, but for basic stuff, man it’s expensive. And quite often, it’s a hassle too. (Feel free to explain to me why this is – the insurance companies, the drug companies, whatever – but try to do it without being a dick, thanks!)

So basically what I’m saying is, I’m super grateful that all of these other countries have had such affordable, quality healthcare that was available to me, without even being a citizen. It’s been a breeze.

And anyway, for now I’ll just hope that if I need medical attention, it’ll be while I’m on the road. Knock on wood (again).

Any Questions, Guys?

Feel free to tell me that if I want health insurance in the US I should just “get a job,” but keep in mind that no other countries have said that to me.

 

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11 Comments

  • Reply Tempesst June 6, 2017 at 12:37 pm

    Woah, that is absolutely brilliant of Nepal to include iron pills with the birth control prescriptions. Such good foresight and a perfect example of taking a holistic view of the patient. I won’t have health insurance again until I start school in August and I’m terrified that something will happen before then because having to get healthcare in the U.S. would bankrupt me and then some!

    I haven’t had any experience with healthcare abroad outside of getting some birth control and antibiotics (also for an infection caused by a motorbike crash) in Vietnam but reading about your experiences just affirms my thoughts that is a perfectly safe and cheaper alternative to getting routine things done in the states. It’s a pet peeve of mine when people (Americans) say something like “I could NEVER imagine getting any sort of medical treatment in a foreign country!” as if doctors, pharmacists, and nurses abroad don’t also go through university, training, and residency.
    Tempesst recently posted…On Coming Home After TravelMy Profile

    • Reply Rachel June 20, 2017 at 5:22 pm

      Ahhh I know! Like doctors in other countries didn’t get any training or years of schooling. (Kind of offensive right?) I’ve just found everything to be so much easier in other countries, so I have zero complaints. Like way less waiting and paperwork and hassle and stress. I’m thinking of getting my annual gyno visit done in Bangkok… because it’s $40 USD.

      Good to know someone else is doing the scary healthcare dance in the US. I’m coming home in October (for a few months at least) and I’ll just have to be very careful I guess. So silly.

  • Reply Carly June 9, 2017 at 11:51 am

    I can tell you what a trip to the ER costs out of pocket… I’m Canadian and was in LA on vacation a few years ago. One night at the Rainbow Room this chick punched me in the face… well the eye. She punched me in the left eye. It was the tail end of the trip and I tried to go about my life just using my un-punched eye. But that left eye was very red and it felt like something was in there. And I have travel insurance, so I was like ok whatever I’ll suck it up and go to an urgent care centre. They wouldn’t see me, told me I had to go to an actual ER because I needed a specialist. INCREDIBLY LONG STORY SHORT there was zero difference in wait time, actual fucks given by the staff or doctors or the level of care I received from what we get up in Canada. Except I paid a grand total of $850 for a dude to look at my eye and tell me “I’m not an eye doctor but its probably ok? Here’s some antibiotic eye drops, you should go see your doctor when you’re home”. Oh and they wouldn’t take my travel insurance, I was out of their “network”. So I had to pay it all upfront and then submit it later when I got all the bills mailed to me at home.

    • Reply Rachel June 20, 2017 at 5:28 pm

      Ahhh! Seeeee! That sounds like a total nightmare, Carly. Also, getting punched in the face? Ridiculous. Gah, at least your travel insurance EVENTUALLY covered it. I’ll just be tiptoe-ing around the US when I get home, very carefully.

      When I was living at home, I’d avoid going to the doctor because even when I had insurance, I had a high deductible plan so it could’ve been hundreds of dollars out of pocket. So stupid.

  • Reply Chris W. July 1, 2017 at 11:46 am

    Seems I’m quite lucky here in the Netherlands 🙂 Healthcare is mandatory (we do pay about 125 USD/month for it though) but covers worldwide. Then a travel insurance (which also covers cancellations and that kind of stuff) of about 12.5USD / month. And I’m all set for 99.999% of destinations.

    I travel about 70% of the year; so happy to know I’m covered! You don’t want to get f*** up in a country where you have to pay first and then get care.

    • Reply Rachel July 24, 2017 at 10:32 am

      Oh man that’s great! I pay about that much just for my travel insurance… which will conveniently expire just as I enter US borders. Just gonna have to tiptoe around when I get there. I can’t imagine how nice it must be not to ever worry about healthcare!

  • Reply Lauren mattick July 9, 2017 at 10:51 am

    I’ve been looking for an article like this, thank you! My friend lives in Chiang Mai and always raves about the dentists there!

    I am fine not having insurance for minor things, but My one big fear is something very catastrophic happening – like cancer for example. Then having to start getting treated in a foreign country, and then go back to the US with a pre-existing Condition and no insurance. This happened to my friend in Australia and she had to stay there for a bit to get treated and the costs were insane. Luckily she is Canadian so she is fine now that she is back in Canada. Is this a fear of yours too? Have you done research on this?

    Also , how much do you spend on world nomads for this long of travel? I purchased it for my 5 week Thailand trip and I can only imagine it would add up with over a year of traveling. Do they have discounts for very long term travel?

    Thanks Rachel! Love your blog!

    • Reply Rachel July 24, 2017 at 10:37 am

      Hey Lauren, I feel you. Thanks for reading! I’m not sure about travel insurance covering cancer anyway – I have my doubts about that. Some of my friends who’ve been traveling for a while have dropped the travel insurance altogether because it’s just cheaper to pay out of pocket for whatever they need IF they need it. And yes, the pre-existing condition thing does worry me a bit. I’m not actually sure what would happen if I got sick here and had to go back to the US for treatment. Honestly, I think I’d avoid going back because there’s nowhere in the world that it would cost more! But no, I haven’t researched it too much.

      As for World Nomads, yes it does get cheaper the more months you travel. I probably spend $1000 per year on travel insurance. I usually purchase it every four months and it’s like $338 or something like that? I’ve never needed it, but I’m too scared to go without it!

  • Reply Sheree August 23, 2017 at 5:03 pm

    I always worry about running out of medication or being struck down ill whilst I am on the road. I agree that it is super reassuring to know that most stuff is available over the counter for a good price. My only tip is to check what you’re being given- In Cambodia I purchased what I thought was a cure for travellers diarrhoea and ended up with Valium! (Sorry, probably TMI!)

    • Reply Rachel September 3, 2017 at 6:18 am

      Hahaha that is quite a mix-up! Yeah, I’m big into Googling meds or asking my mom (she’s a nurse). I asked for something to help me sleep on the overnight buses in Vietnam and they also gave me Valium! I guess that’ll work…

  • Reply get Budget Policy in United States of America October 10, 2017 at 2:46 am

    Thank you for sharing your post. i suspect it’s much more common than you think.

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