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The American Patient

I just spent six nights in a hospital, for a condition that could have been treated with pills at home.  For the first four days of my hospital stay in Santa Cruz, Bolivia, I had no idea whether my admission was justified or not.  To my face, the doctor told me 2-3 days; but in a private conference with the Director of the American School where I work, he said it might be closer to ten.  Having heard beforehand that anyone showing up at a hospital after 9:00, who could prove they had insurance would be admitted, I wasn’t sure what to think.

The diagnosis was an infected colon; ulcerative colitis accompanied by e-coli to be exact.  For days, I wasn’t sure whether my condition was serious or not.  And if you’re a third-world traveler, you’d best prepare for similar uncertainty if you become ill abroad, because in many cultures, doctors aren’t as blunt as they are in the United States. 

In the States, a doctor generally guesses conservatively when giving you the prognosis for your health.  If the doctor says you’ll be in the hospital for ten days, chances are it’ll be closer to five.  If you have cancer, you’ll most likely be given the worst-case scenario first, and then they’ll move on to more promising news.

My experience in Bolivia is teaching me that here, and I’m guessing it’s the same in many other underdeveloped countries, that the condition of a patient’s psyche is valued more than telling them the truth.  Rather than bluntly tell you what is wrong, doctors would prefer you not get upset, and so they simply give a vague description of your condition.  It’s all good, until you find yourself resting in a dank hospital room, with an IV protruding from your arm.

What was most frustrating about my third-world hospital stay was what I perceived to be a constant lack of credible information.  Even with a spouse present that was fluent in the language, it was exceedingly difficult to get a consistent response regarding my condition.  At first, we simply thought we’d be admitted for a night or two to begin antibiotics and have an IV inserted for re-hydration.  However, by morning there were so many different things being said, that I was seriously beginning to wonder if I’d make it out alive.

The confusion started when I woke up to the sight of my doctor, my school’s Director, and the school doctor standing at the foot of my bed.   My wife and I were told that I had an infection in my colon and that I would need to stay in the hospital for three or four more days.  I’d be administered antibiotics intravenously and probably be home by the weekend. The posse then proceeded to exit the room for a private conversation.  When the Director came back five minutes later, the story had changed yet again.

“You’ve got a very serious infection in your stomach and it’s going to take at least five or six days before you go home,” he proceeded to tell me.  “If it’s not treated you could get a perforation in your colon and die.”

Now, I was defiantly alarmed.  The worst part was that I didn’t know if my Director was embellishing, or if my doctor had told a completely different tale in private.  Unfamiliar with the medical customs of the culture, I didn’t know if my condition was relatively minor, or if I’d be under the knife in a matter of hours.

At least if the doctor had said I was in imminent danger, a medivac could have been arranged, and I could have touched down in Miami in less than ten hours.  This was an extreme option.  Not one I wanted to take unless my life was truly at stake.  Fortunately, I didn’t have to.

But it poses the question, what should a traveler do when put in this type of situation?  What questions must you ask if you find yourself tethered to an IV pole in a third-world hospital?  As a survivor of this unique type of experience, I feel I’m now qualified to offer some useful advice.

First off, before you’re admitted to any hospital, (if it is possible) ask your doctor how long you’ll be staying, if there are no complications.  And ask for the rational behind the length of your stay.  Tell the doctor that U.S. patients are used to hearing the blunt truth about their condition and that you’d be very upset if anything was hidden from you.  As a U.S. citizen, I was alarmed when I heard that I might be in the hospital for more than two days.  Back home, such long stays mean something quite serious. 

However, if I’d followed my number one rule, I would have saved myself worrying over the projected length of my admission.  As it turned out, the reason I needed such a long time was because the antibiotic I needed, could only be fed intravenously (though it is available in pill form in the United States).  A month earlier, the only available oral antibiotic had failed to knock out my initial infection.  My doctor knew this from an earlier conversation, so he knew he needed to try something different.  In essence, I wasn’t in the hospital because of possible danger, but because it wouldn’t have been practical to do the IV at home.

The second thing to remember if you find yourself lying in a third-world hospital bed, is not to listen to the diagnosis’ of those who aren’t doctors.  If you feel uncomfortable with your initial diagnosis, you certainly should request a second opinion.  Hearing two concurring opinions from medical professionals is reassuring and will do much to ease any trepidation you may have about the state of your health. 

However, hearing rumors from people who have lived in a country for a long time, but who know nothing about medicine, is not.  I never should have put any stock in the doom and gloom possibilities mentioned by my school Director.  Had I followed this simple rule, I would have slept at night, instead of worrying about my mortality. 

Am I saying trust the doctor without question?  Absolutely not.  But what I’m saying, is don’t be afraid to straight up demand a second opinion.  I’ll warn you.  It’s probably not as culturally acceptable to question a doctor’s diagnosis in many countries.  Your doctor may get upset and try to convince you it isn’t necessary.  So what if it isn’t?  It’s your body, your life.  If a second opinion is what you need in order to sleep, then by all means demand it.  After all, it could end up saving your life.

My last piece of advice is to have a medical plan of action before you embark on your third-world travels.  If you’ll be working in the country, ask your employer what the procedure is in the event that you need a medivac to a more advanced hospital.  If you’re traveling on your own, call the embassy in the country where you’ll be going, and ask them how you would arrange a medivac transfer, in the event that you need serious medical attention.  Before you leave, speak with your doctor about the most likely reasons you might be hospitalized, and ask how those maladies should be treated. 

Yet again, had I followed my own rule, I would have saved myself considerable worry.  Once I was able to speak with a friend of mine who is a doctor and confirm that my treatment was appropriate, I felt much more at ease with the entire situation.  Had I asked ahead of time exactly how to instigate a medivac should I have deemed it necessary, I wouldn’t have been making frantic phone calls from my hospital bed at a cost of 50-cents a minute in order to find out.

I think the most important piece of advice for someone who needs medical attention in a third-world nation, is to be firm and direct with both your requests and your questions.  Don’t be intimidated by the situation and by all means don’t worry about offending someone by asking for another opinion.  Hospital stays are scary enough in developed countries, where the quality of the care is not called into question nearly so much.  So don’t enter your travels blind about what to do in the event that you find yourself hospitalized.  Come prepared, know your rights; ask tough questions.  If you do these things, one day you too may be qualified to write a travel article on how to survive a third-world hospital stay.

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