Sunday, 10 March 2013

The Amazing Race 22, Episode 3

Bora Bora (French Polynesia) - Papeete (French Polynesia) - Auckland (New Zealand) - Christchurch (New Zealand) - Denpasar, Bali (Indonesia) - Ubud, Bali (Indonesia) - Bukit Peninsula, Bali (Indonesia)

The Amazing Race 22 continues to provide case studies in travel under adverse conditions.

At the end of a double leg that kept the racers on the run for four days straight, John and Jessica finished last in a memory challenge and were eliminated despite having an unused "Express Pass" that they could have used to skip a challenge. Learn to recognize when you are sleep-deprived, jet-lagged, or otherwise impaired, so that you know enough to postpone making important decisions at such times.

Meanwhile, Connor the professional bicycle racer and his father David finished first in both halves of the leg, despite David being on crutches after having ruptured his Achilles tendon in the sprint down the beach to the finish line at the end of the previous episode.

The TV production crew accompanying the cast of The Amazing Race includes both a physician and a psychiatrist. And David had his ankle examined at the clinic in Bora Bora, and imaged at the hospital in Papeete, before deciding to carry on with the race.

Not every traveller, of course, has a doctor in their entourage. In the real world, time pressure (how will I catch up with the tour, or get to my destination before the end of my vacation, if I stop long enough to find a doctor?), a commendable but misguided desire not to complain or spoil others' trips, and a generally excessive fear of foreign doctors often lead travellers to postpone medical treatment, even in the face of significant pain or other symptoms.

I've been surprised at how often people who ought to know better tell me about having done lasting, often permanent damage to their bodies by going on with a planned trip despite illness or injury. Yes, it may be (although really it rarely is -- you can come back another time if you want to) a once-in-a lifetime opportunity to get to some place or have some experience. But are memories that will last a lifetime worth chronic pain or other symptoms that will last a lifetime? I doubt it.

One reason people find excuses not to seek professional medical help while travelling is that finding a doctor abroad raises so many questions and fears. I'm not a doctor, but here are some practical suggestions for how to find one:

Will I be able to find a doctor? Probably -- if there's one around. In any big city, even in the Third or Fourth World, there are some people who can afford good medical care, and some providers of such care. Medical care is a universal human need, and doctors tend to be locally prominent. Anything can happen, but it would be unusual for there to be a doctor or advanced medical facility around, but for you not to be able to find it. Transportation to the nearest doctor or medical facility (more on that below) is more likely to be an issue than finding where they are.

How can I find a doctor? If you are injured, and obviously need medical help, people will probably take or direct you to whatever medical aid is available nearby. If your illness or injury isn't apparent, ask local people where to find a doctor, clinic, hospital, or other medical facility.

If you want the best available care or advice -- especially in a place where most of the people are too poor to afford advanced medical care -- ask people who can afford good medical care for themselves where they find it. That might mean asking a member of the local gentry, like the owner of the local guesthouse or Internet cafe, or a local expat. Or ask the concierge at a hotel that caters to wealthy foreigners, even if that isn't where you are staying. This is no time for misguided thrift. In a very poor country, you want to see the doctor who cares for the local elite, or for wealthy foreigners, even if you are staying in budget "local-style" accommodations. As a last resort, I might even contact the local embassy or consulate of the USA or another wealthy country -- something I would rarely do for any other reason -- for a referral to a doctor.

Will travel insurance help me find a doctor? Probably not. Medical insurance and other sorts of insurance for travellers are beyond the scope of this column, but in general their value (if any) is in reimbursing your out-of-pocket medical expenses after the fact, not in expediting treatment in the event of a medical emergency.

The person who answers the phone at an overseas "travel assistance" call center is unlikely to know more about where or how to find the nearest doctor or clinic than the people around you. And requirements for preapproval, or that you be treated by the provider or facility of their choice, are only likely to cause delays and run up your international phone bill. The only time such a service is likely to be useful is if medical evacuation by air ambulance is necessary.

Will a local doctor speak English? Maybe, maybe not, but it probably doesn't matter as much as you think. The doctor or clinician's expertise and equipment are probably more important than their linguistic ability, especially if finding an English-speaking doctor might require delay and/or travel before you could be treated.

If you've been in a motor vehicle crash, most of the assessment and diagnosis of your injuries is likely to be carried out by physical examination rather than conversation. Even if you have more complex symptoms to report, you may be able to get by with a dictionary or an online translator. Dictionaries and robo-translation often work better for technical communication within a specialized field than for general conversation. If possible, look up any key vocabulary before you head for the doctor, since there may not be a dictionary handy at the doctor's office.

It wasn't entirely clear, but on the TV broadcast of the race it looked like David had recruited a sympathetic French-speaking tourist to go with him to the hospital and translate the radiologist's advice about his ankle. I think that's a wise tactic, even if you have to pay a translator. There's a chance that a doctor almost anywhere in the world might speak English, but their English might not be reliable if it's not the language in which they studied or that they use regularly. Where there are few medical professionals, and all of the the best-trained ones around speak French (as in French Polynesia) or Spanish or Russian or Mandarin or whatever, and not English, I'd rather deal with a good doctor through a translator than with a hack who happens to speak a little English.

Searching out an English-langauge doctor is especially likely to be counter-productive in places where some other language is the dominant second language, so that English is at best a third language even for most highly educated people.

How much will it cost to see a doctor? Less than it would in the USA, in most places -- even if you are charged extra for being a rich American. Medical treatment in the USA is so much more expensive than almost anywhere else in the world that sticker shock for foreign doctors' bills is almost unheard of for people from the USA travelling abroad. The worst case is that you might be charged as much as what similar medical services would cost in the USA, but that's rare.

The doctor may come to you: It's normal for doctors in France, among other places, to make house calls. On the other hand, getting to the nearest doctor could be much more expensive, slower, and/or uncomfortable than an ambulance ride on a smoothly-paved U.S. road. If you are riding on the back of a motorcycle because the only track is too narrow for four-wheeled vehicles, and you get hurt, the only way out is likely to be on the back of another two-wheeler. On an island, or in a wilderness area, you may have to charter a boat or an air taxi -- if you can find one. And there are some big Fourth World cities -- although fewer than most First Worlders think -- where anyone who can afford to do so goes abroad for all but the most urgent medical care.

Be prepared for surprises or confusion if you ask for the bill in a place where local doctors aren't used to treating visitors from the USA. In a country where most or all medical services are paid for by the government, you might be treated for free on the (false) assumption that like most other civilized countries the USA has reciprocal agreements between our (nonexistent) national health system and those of other countries. Or you might encounter doctors or clinics who have rarely or never dealt with a cash patient, and have no idea how much to charge you, even though they know you are supposed to pay a "market" price.

The "pit stop" where the cast members stayed and where this double leg of the race began was a luxury resort on the Bora Bora lagoon that, according to the fine print in the credits, had paid to get its facilities featured in the TV show. The racers had neither time nor opportunity to get further afield, except for David's detour to the hospital in the capital, Papeete, while the racers were changing planes on Tahiti, the main island of French Polynesia.

If you have more time, less money, and/or want to get to places in the South Pacific less dominated by tourism than an all-inclusive resort on its own "motu" (islet), your best guide is David Stanley, author of the Moon Handbooks to the region and the SouthPacific.org Web site.

David Stanley is one of the Moon Handbooks and Avalon Travel authors who make me most proud to share the same publisher. Long before "ecotourism" became fashionable or even acquired a name, David Stanley's guidebooks have been distinguished by attention to, and respect for, the distinctiveness and fragility, both physical and cultural, of island ecosystems, as well as a conscious and explicit antipathy to the commodification of travel. Even if you consult other resources, David Stanley is an essential source for whatever the tourism industry and its commercial and governmental boosters won't tell you about the place you are thinking of visiting.

Moon Handbooks South Pacific covered every island group in the vast stretch of ocean south of Hawaii, east of New Guinea, north of New Zealand, and west of the South American mainland. It's no longer in print, but remains valuable background reading on the region. I keep a copy of the final eighth edition in my collection of out-of-print destination references.

David Stanley continues to maintain updated print editions of Moon Handbooks Fiji and Moon Handbooks Tahiti and French Polynesia. Much of the general information on the rest of the region from the South Pacific Handbook is now available at SouthPacific.org.

Link | Posted by Edward on Sunday, 10 March 2013, 23:59 (11:59 PM) | TrackBack (0)
Comments

You may not have to actually call the (US or other) embassy to get a referral. When I needed an ophthalmologist in Tbilisi I found one from the embassy website.

I would also stress the need for evacuation/repatriation insurance as well as medical insurance. When I broke my wrist in Switzerland I got myself to the hospital, but the repatriation insurance got me home. (Evacuation insurance only gets you to a medical facility, not necessarily back home.) I don't care how young and healthy you are, accidents may still happen.

Posted by: Kathy, 12 March 2013, 15:31 ( 3:31 PM)
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