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While You're Away: Visiting the local doctor

local doctorMuch of my job involves giving pretravel advice to longer term volunteers, and then providing on the spot (e-mail) advice when the predeparture advice doesn’t work out! So I have received lots of long distance phone calls and e-mails from people sitting on the can, and in foreign doctors’ offices. I thought I would share my experiences with you.

Firstly, it is not easy getting sick in a foreign country. You feel awful, your temperature is 103°F/39° C, you are alone, you don’t understand the local doctor, and your Mother isn’t with you. The following points are what I think is important. They are generalizations.

  1. Learn about the important medical issues BEFORE you leave. If you are headed to the tropics, this means malaria, diarrhea, animal bites, STDs and your personal safety. If you wait until you are sick, you will only hear misinformation from other expatriates, or hear it in Swahili, or through the haze of your illness.
  2. If at all possible, take a friend, or advocate, with you when you go to see the doctor. They can ask the right questions, and remember what the doctor told you.
  3. Illnesses such as malaria (and typhoid) are OVERDIAGNOSED in the tropics.
  4. Diagnostic facilities are usually not available, and if they are, they are highly unreliable. Diagnoses of malaria and typhoid aren’t to be trusted.
  5. Local doctors practice POLYPHARMACY. I would probably do the same in their shoes. This means they might treat you for several conditions and many symptoms at the same time. “Here, take these seven different pills and come back in three days if you are not feeling bettter.” This may include an artemesinin derivative for malaria, ciprofloxacin for typhoid and diarrhea, an antiparasitic such as metronidazole or tinidazole, and something for your fever … your diarrhea … your nausea … your cramps and some probiotics. That’s almost seven!
  6. I think that that approach is OK, as you are unlikely to die from the seven different pills! But, you should know in advance which of those seven pills are most important, i.e. which one is for malaria (usually an ARTEMESININ derivative), which one is for a bacterial infection such as typhoid or diarrhea (usually ciprofloxacin), and which ones are for symptomatic relief.
  7. My experience has shown me that amongst the ciprofloxacin, the correct antimalarials, time and prayer … everyone seems to recover.
  8. Local doctors are more likely than Western doctors to treat you with an injection. Do your best to avoid these injections if at all possible, or be absolutely sure of the source of the needle.
  9. It is not a bad idea to have someone to contact by e-mail if you are not getting better.
  10. Make sure you travel with adequate health insurance.

Content (c) Mark Wise
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