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The Admiral's Angle         

Admiral’s Angle # 30 - Taking Care of Ourselves

Concerns about health care preoccupy most cruisers preparing to go away from their home country the first time.  In the First World, we tend to associate the quality of health care with the quality of its infrastructure – nice offices, state of the art equipment, and big staffs.  We imagine we will not find that in countries where people still live in tin-roofed shacks.  What will we do if we have a problem?

The good news is my admirals assert that they are much healthier cruising than they were back home.  They attribute this to spending more time outdoors and less in crowded or enclosed spaces, to being more active and having a better control of what they eat, and of course to living more stress-free lifestyles.  However, just as things do go wrong with the boat, no matter how careful our maintenance, things can and will go wrong with our bodies as well.

Some cruisers are more regimented in their preventive care while others wait for problems to crop up.  Most of us have been taught to maintain regular checkups, gynecological exams and mammograms, as well as, more generally, dental and eye exams.  Because of living so much in the sun, most cruisers add dermatological exams to that list.  Cruisers who migrate regularly back to their home base often schedule their checkups with their regular doctors. This has the advantage, particularly as you get older, of having someone who has a baseline on your health against which to plot changes, and it is particularly desirable, if you have a physician you like and trust, if you can arrange to communicate with him/her by email when issues come up.

But overseas cruisers who do not fly home or who do not have such long-term trust relationships usually choose to get checkups and care from local doctors as they need it.  It is probably true that in many of the countries we visit, the infrastructure of fancy offices and new equipment may not measure up to what we are used to.  But it is also true that most cruisers find they get just as good care as they would at home at a fraction of the cost and can even get great deals on elective surgeries like LASIK, tooth implants or cosmetic surgeries!  And guess what?  Sometimes the facilities and equipment are more advanced than back home!

Kathy of Hale Kai gets all her check-ups and tests done in the Caribbean.  “It's easy to find the name of a good doctor through the cruising grapevine. A doctor's visit generally costs about $20, the doctors aren't in a hurry like they are in the US, plus they don't delegate away as much of the work. You can even order tests that you want directly from a lab without always having to go through a doctor, and they, too, usually cost less.”  I personally can second that finding for Central America, Mexico, Polynesia and Fiji. To make things easier and more complete for foreign physicians, many cruisers, particularly those with ongoing conditions, carry an onboard file of recent tests, exams, or x-rays.

Lower costs for medical care lead some cruisers not to bother carrying medical insurance.  These uninsureds are usually younger (invincible!) folk, individuals on tighter budgets, or those who have Medicare to fall back on.  Regarding invincibility, a young cruising family we know recently had to air-evac out their eight-year old daughter for suspected appendicitis. The evacuation, the surgery, and the week’s stay in the hospital ended up costing them about $4000 after the hospital cut its bill in half.  The father figured that would have been about the cost of medical insurance for his family of four for a year.  But what if the hospital hadn’t cut their fees, or what if something else happens?

A majority of my Admirals do carry medical insurance.  Some are lucky and have health care coverage through their husband’s military benefits or through their own retirement packages.  A few purchase non-US insurance, such as the popular plan in Mexico for about $250 or similar plans in Europe.  However, most of the rest carry private insurance with high-deductibles conceived to protect them against catastrophic accidents or illnesses while paying for routine medical expenses out of their own pockets.  Two international policies popular with cruisers from IMG (www.imglobal.com) and IHI (www.ihi.com) cover cruisers inside and outside the US, although the premise is that you remain outside the US much of the year.  Wherever your coverage is from, be sure you understand the ramifications of your policy. For example, a typical domestic policy might only cover you outside the US for 60 days, while one of the cruising policies won’t let you be in the US for longer than six months.   

Mary of I Wanda points out a curious plus of private insurance. “During our cruise, Christian was diagnosed with cancer (and successfully treated). Had we still been working, this would have ended our cruising dream, because once you have a serious condition you become uninsurable in the US. We would have had to continue working until we were eligible for Medicare -- 27 years later!”

Many cruisers augment their insurance with very affordable DAN insurance (www.diversalertnetwork.com). Even for cruisers who don’t scuba dive, membership in DAN includes DAN TravelAssist, giving you up to $100,000 of evacuation assistance coverage.  It was DAN that covered and coordinated Randy of Procyon’s air evacuation from the Galapagos to Quito that I wrote about in this column in the Jan. 08 issue. 

Of course there are many times when we cruisers are out of reach of shore-based medical care and must take care of ourselves.  First-aid courses and kits are a must, and some cruisers augment these further with EMT or wilderness medicine training. Most physicians in or out of the country will write prescriptions for drugs like antibiotics and painkillers that cruisers could need in offshore emergencies or remote situations.  “We do self-treat far more readily than we would if we lived in the US,” says Mary of Camryka from Panama, “keeping a supply of antibiotics, antihistamines, painkillers, treatment for dysentery, etc. and relying on our Merck Manual and other books such as Where There is No Doctor.”  Additionally, the HF radio, particularly Ham radio nets, become indispensable for seeking emergency help from volunteer physicians on call, particularly on passage.

There are several areas worthy of special attention for cruisers wanting to keep healthy in the tropics.  Keeping hydrated is important; dehydration can bring on urinary tract infections, contribute to kidney stone formation, exacerbate the effects of diarrhea and muck up body chemistry when scuba diving.  Another is protecting yourself from insect bites (and diseases they transmit like malaria or dengue) with protective clothing, screens,  and spray with DEET as well as treating bites promptly with sting-sticks or hydrocortisone cream so you don’t scratch.  Cuts, sores, blisters, scrapes and scratched bug-bites MUST be treated with topical antibiotics, covered with band-aids, and kept out of sea water (although sterile saline – boiled water with added salt—is good) to control rampant infections.  This past season in the Pacific, we have personally known a half-dozen cruisers struggling with infections, including two that had to be med-evac’ed out, and one who nearly lost his foot!   As a doctor in Fiji told my husband, “Americans hate to cover sores, but in the tropics, a bandage is a must.”

So, in the end, overseas cruisers find that health care is far less a preoccupation than they worried it might be.  Most first aid kits are tapped for little more than band-aids and antibiotics, and medical help is available when you need it.  Indeed, by the time you have some years of experience under your belt, you may find yourself preferring the simpler medical systems overseas to America’s McMansion medicine. 

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