Somewhere on Perhentian Island, off the northern tip of Malaysia, an exhausted Ernst watched television, slept, and coughed while waiting for Renee to return from a day of scuba diving. He wanted to see whether the medicine would vanquish the pneumonia. The doctor had warned that if there was no improvement, Ernst would need to go to a big city and a real hospital – ending his backpacking with a likely return home to Denmark.
After a restless week, the drug proved effective; Ernst returned to backpacking and diving. He and Renee continued traveling around Malaysia, reaching Sipadan where I heard the story. Their experience illustrates the decisions that face long-term travelers when illness strikes. Is local medical treatment adequate? Can I postpone my plans or onward tickets? How does this situation affect my travel budget? These initial questions – while tough – are merely logistical. When I was asked to take an additional medical test in Singapore, I had to delay a ticket and shorten my itinerary at the next stop. Travel change, easy; waiting for test results, difficult.
On a deeper level, backpackers are usually independent people. Most have sacrificed something significant to make the journey: a job, a car, an apartment. We like to solve problems of language and transportation and finding food. Every obstacle is part of the fun; we feel good when we’ve put the jigsaw puzzle into place (and the photos on a blog).
What about when that obstacle is your own body? This presents more and deeper questions: what did I do wrong that got me here? Can I ignore this and keep going? Do I tell friends and family? If I stop now, will I feel like I failed? Is there anyone here who can help me through this?
We may be in a position to ask for help from a stranger. Luckily, friendly faces are usually at hand, such as staff, a server, even the neighborhood pharmacist. They are likely to have the language skills to listen to the problem, plus they know the local medical scene better than a traveler. They can probably recommend where to go and, just as important, places to avoid.
Chin up, there may be some silver lining, however small. You may experience unexpected acts of kindness that you’ll always remember. You get a glimpse into a different healthcare system. Health services may be less expensive than in your home country. They may be cheaper and more enjoyable to recuperate near a beach/mountain/forest, or wherever you happen to be
On the flip side, the only one to manage this care will be you; no government or insurance administrator is looking over your shoulder – or telling you who the qualified doctors are. You won’t have the comfort of knowing the credentials and costs of the local caregivers. Trust your instincts and walk away from any place that makes you suspicious or uncomfortable.
Consider whether it is essential to get care immediately, or whether you can wait until reaching a major city, maybe a stop where you are staying with a friend. After you have a recommendation for a doctor or hospital – from accommodation staff, or your embassy’s web site – get one for a second and third option as well. If you are uncomfortable with language, personality, or hygiene – and can still ambulate – then check the other suggestions. (Yes, this is similar to shopping for groceries, only more serious, so the research is important.) Ask ahead of time the cost for each consultation and find out the method of payment. Be aware that counterfeit medicines are common in some places, such as southeast Asia. If your medication has a neutral or bad effect, cease using it. For a serious illness, it is worthwhile to get to Bangkok or somewhere with reputable medical practice. Women: it’s a good practice to have a second person in the examination room if you must disrobe. Should your exam be performed by a male doctor, ask for the nurse or receptionist to join you.
Happily, the majority of accidents and illnesses are minor nuisances. They may delay us for a couple days while we wait for the meds to help, or the swelling to reduce. Carry playing cards and an extra book or magazine, enough for at least one day of idle time.
If you do face a difficult choice, review your options and consider whether healthcare on the road is feasible. Sometimes it might be preferable, especially if the care is good quality and affordable. Sometimes it might be mandatory, if an injury stops you from going anywhere.
In rare cases, you may need to return home for follow up or long-term care. Support from friends – and also from other backpackers – can be important to your healing. Share your story, ask for encouraging thoughts and words, and know that you are not alone.
I can truly say – after sharing a Sydney hostel room with a 67-year old backpacker from South Africa – there is always next year!