Let’s Go On Holiday

And Stay Healthy !!!

The dictionary definition of holiday is a period of cessation from work or, a period of recreation. It is certainly not the sort of definition or description that most people would offer when asked the question but, in reality, it is broad enough to be accurate. You might choose a week in the West Country or the Lake District, perhaps a weekend in Paris or two weeks in Benidorm or even lash out on Florida, Bangkok or a cruise around the Alsakan coast. Whatever you decide to do and where to go it will be different from what you do at home and it will usually cost a lot more too!

Often, many months are spent saving for the holiday while the anticipation and planning generate a mounting feeling of excitement as the day grows closer. But the one thing which hardly anyone gives a second thought to is the planning of what to do if something goes wrong. It is only human nature, after all, to put a mental block against things that we do not like and illness and injury are usually the first things that are stored in the ‘don’t want to know’ file. After all, you have paid the insurance premium – you have haven’t you? – and so if things don’t go as planned it will be the responsibility of the metaphorical ‘they’, won’t it.

Very few people have even the slightest idea of what medical facilities are available south of Dover. The European Community is not too bad because of the reciprocal health care facilities that exist with our national health service. But once you go beyond, things change very rapidly. In America and Canada the standard of care is excellent but at a price. Something as simple as a throat infection can set you back $500 for the doctor’s fee and the drugs, and if you are unfortunate enough to suffer a heart attack someone is going to have to pay bills of between $5000 and $500,000, depending on the complications and the treatment you receive. Try back packing in Africa. Without any doubt he sights and sounds are wonderful but if you are in need of a doctor I can assure you that they are as rare as zebras in the New Forest! And even when you manage to find one, the chances of getting the treatment you need for your complaint is very hit or miss. What about exploring some of the magnificent sites which have been hidden behind the communist block for so long? No doubt the experiences and mementos will be a talking point for years to come, but so will the ordeal you would go through if you were unfortunate enough to be taken ill. Outdated equipment, scarcity of essential drugs, sterilised old glass syringes and needles and a desperate shortage of everything will certainly be memorable!

Lunch at Lilongwe Hospital, Malawi

Special Air Courier Service, New Delhi

But please don’t let me frighten you with these facts. Statistics show that only a small proportion of travellers need to seek medical help when they are on holiday and an even smaller proportion are sick enough to call for help. So the chances of your being one of the unfortunates is very small indeed but, even so, you do need to take precautions. Now I’ve already mentioned the insurance premium haven’t I? Just make sure that, before you set off on the journey, you have filled in the form honestly and paid the premium. At the end of the day, provided you have stuck to the rules, it is the insurance company that will be your friend in need and it is they who will be footing the bill for your medical costs. So where do I, as an in flight medical officer, fit in to the picture. Before I tell you that, let me describe the mechanism and machinery that gets into gear when your cry for help arrives and then I will tell you how that cry eventually comes down the line to me.

Let me describe the scenario when an unfortunate, well insured British traveller suffers a heart attack when on holiday. Naturally the first thing to do is to seek medical help quickly. At this stage don’t worry about bills and demands for payment because the first thing to do is think of yourself and the care that you need. The next thing to do is to ask your partner or friend to contact the insurance company on the emergency number that they gave you and answer all the questions. From that point on everything will be taken out of your hands – with a few exceptions, because not all insurers work to the same rules.

The insurance company will then pass on your details to what is known as a repatriation (repat) company. The principle is the same as when you dent your car; of course you will notify the insurer but they will then delegate the job to a specialist car repairer. The repat company are the specialists in monitoring your medical problem when you are abroad and, when the time comes, getting you, your family and your belongings home.

Our unfortunate patient slowly get over his heart attack until the time comes when the repatriation referee – usually a doctor or a specialist nurse – decides that all medical criteria have been satisfied, the treating hospital are prepared to let him go and the airline company rules have been satisfied. This is where I fit into the jigsaw.

A telephone call will be made to ensure my availability, and this is usually giving me twenty four hours notice if I am lucky! All the medical details will be faxed or emailed through to me and I will make a second check to ensure that all the criteria have been met. All my in flight medical monitoring equipment is packed, my emergency treatment equipment and drugs are checked and I am ready to go. From this point on everything should go smoothly and the unfortunate patient is usually delivered to his home or hospital within a couple of days. Once again there are exceptions to this rule and things sometimes don’t go as planned, but this is where my experience takes over and the whole point of the exercise is to get the patient home without any responsibilities resting on his shoulders.

I have explained one particular type of scenario where a doctor is needed to accompany the patient home. This isn’t always the case because the involvement of the repat company depends on the type of illness or injury that is reported to them. Simple illnesses often just need advice as to what to do and where to go. Others may just need a non medical escort to help the incapacitated patient through the immigration / emigration barriers and luggage carousels. And there are those who need some more specialist assistance but where a nurse escort will be the best option. Depending on the circumstances and the country, the patient may be asked to foot the bills himself and reclaim them when he gets home. On the other hand the repat company may provide a cost guarantee to the health care provider or, as often happens, the escort may have to pay the bills to the foreign hospital before they are prepared to let the patient out of their hands!

The Southernmost tip of South America

Guess Where !!!

Whatever the scenario, the repat company are the ones who will be at the end of a telephone line ready to take over the many ramifications of health care abroad. Sick people are never the best ones to make critical decisions, let alone in foreign surrounding. and faced with a babble of foreign languages. In this book I will share with you many of my experiences both from the viewpoint of the in flight medical officer and those from my earlier days when most of my flying was at ground level! I will tell you some sad stories and some very happy ones and, at the same time I will try to give you some personal impressions of the countries that I have had the fortune to visit.

Above all, I will try and reassure you wary travellers, who have remembered to fill in the insurance form, that help is at the end of a telephone call should you be unfortunate enough to need it. But just remember that the national health service stops at Dover. Wherever you travel to it will be very different from what you are used to and I can certainly assure you that they don’t do house calls in Africa !

Barrie Davies