Wednesday, April 05, 2006

Info about what really happens when you get sick traveling in a foreign country: France and Italy


The following was written by Martha S. Taccarino and was submitted as a "Travel Note" in the Slow Travel Contest 2006 in the fall of 2005.

So what really happens when you get sick in a foreign country? For two relative healthy adults my husband and I seem to be trying to find all the possible answers. On the last two out of three trips to France and Italy one or the other of us has had to seek medical care.

My husband, Ben, started it all. Three years ago we were meeting another couple in Nice. Our itinerary was two days in Nice, a train ride to Livirino and overnight there, then a rental car to a rental house for a week and finally a train ride to
Rome for a four-day stay then flights home. We were using frequent flyer miles so we were on separate airlines. Ben dropped me off at Dulles [outside Washington, DC] and hours later I arrived in Nice. He arrived three hours after I did. Somehow, somewhere in the 20+-hour period that fell between his dropping me off and his arrival in Nice he caught some cough, cold virus combination.

He was tired when he got to Nice and immediately slept the rest of the afternoon and most of the evening. The next day he was persuaded to do a few things. The third day was the six-hour train ride to Livorno. He slept through all of that. Early the next morning, he irrationally decided to go by himself to Pisa to pick up the rental car that we all were to share. Since he was the only one at the rental counter he really was the only one who should have been driving it. He planned to go by the Hertz counter in Arezzo near our rental house to sign the rest of us up. A good plan except that when we got to Arrezzo we could not find the Hertz counter anywhere. It was not across from the train station as Hertz Pisa had assured my husband it would be. Finally, after the third frustrating day of driving and asking and looking with the sick person driving and the other three of us stuffed in the car, a passerby overheard me again asking for information and gave us valid directions. Of course by the time we got there it was closed for the day. Frustration levels were at a new high and a revolt by the three passengers occurred. I was picked as the uninsured driver and plans were made to seek medical help for the sick person who insisted he was fine even as he was dropping off to sleep as soon as the car was stopped.

Since we were at a rental house we turned to the lady who owned the house.
She was very concerned and immediately called her doctor and told him of the situation. She sent us to his office in the small town nearest our house. It was a fairly new two-story office building with each office having a door that opened to an outside walkway. Ben and I went in to the small outer office and there were people sitting in chairs lined up against all the walls with a small space for the outer door to open. I got him situated and went to peek around the corner for a receptionist. As soon as I did that I could hear a collective intake of breathes from everyone else in the room. There was no receptionist. I was about to open the door directly into the doctor’s examining room. Somehow I realized I should not do that and went to sit down by Ben. With gestures and a combination of languages it was established that we followed the man in the blue coat. Someone else walked in and we were able to see the pattern that we should have followed. The dance of the door, should it be open, should it be closed? Who was with who and who the new arrival would follow. It was all very orderly. I found it amusing, Ben just grunted.

People moved in and out fairly quickly, five minutes or less with the doctor. Our turn arrived and we went in. A few minutes of conversation established who we were and that the doctor spoke French and Italian. Ben speaks English and some German. I speak English, some French and very little Italian. Somehow patching together languages and pantomime we went through symptoms, existing conditions and medications. The doctor was very thorough. He spent at least 20 minutes with us. He wrote several prescriptions. Very firmly told me that if Ben got worst we should not delay but go directly to the hospital. After about twenty minutes with the doctor we were ready to leave. I asked about paying, being billed, and offered a credit card and the doctor just shrugged. It was clear the government was paying him. No records of our name or contact information had been filled out. No insurance information or deposits or promise of first-born children had been required. We thanked him profusely and left.

I took Ben back to our house and waited for the daily 2 hour lunch period to end before trying to get the prescriptions filled. The pharmacist again questioned me about existing conditions and other medications that Ben took before filling the prescriptions. I would love to be able to write and to remember that after the first dose Ben was just fine but that was not the case. He took everything as directed but never really got better. Finally after the train ride to
Rome he left two days early to come home and see his own doctor. She felt that everything the doctor in Italy had done was correct and it was a matter of time before Ben would feel better and he finally did.

This year my medical experience began after a week of travel. We were in
Italy when I began to feel a dull ache in the kidney area of my back with sharp shooting pains traveling around to the front of my body. After all the mineral water and bouncing around the mountains of Corsica in a rental car I was sure it was a kidney stone. I have had small ones before and passed them with a small amount of difficulty. I figured I could handle it with perhaps a painkiller. I went to the pharmacy down the street from our rental house in Lucca. After discussing my problems and my diagnosis in my limited Italian and his limited English, the pharmacist and I worked out what I should take. No questions about other medications, pre-existing conditions or anything. He did admonish me to drink lots of water.

I was back the next morning. What he gave me was ineffective. He offered stronger. Again no questions about other medications. I bought it and read the insert. There were many DO NOTs. I was not happy with that but my only other choice was a doctor. Fearing getting slapped in a hospital I figured out an almost workable combination of one pill, wait several hours and have some wine. With that and long soaking bathes the pain became bearable. It was the constant consumption of water and its resulting need for it to be eliminated that became a real problem. In many places it is not easy to find a bathroom. Fortunately, my husband and I have a very relaxed manner of traveling so we worked around my woes.

I carefully hoarded my little packet of DO NOT pills so that I would have one dose left for our first full day in
France. After our late afternoon flight from the south and a challenging car ride in the rain we ended up at a small hotel in Giverny. It was late and dark when we got there. We had no idea how many rooms were being occupied. After dinner we went to our room and prepared for bed. I needed to soak in a bath. That is when I noticed it. An ugly, ugly weepy rash from the middle of my back to the middle of my front. I was horrified. I knew that this was no longer a case of a simple kidney stone. It was shingles, a virus, that I remembered is somehow connected with chicken pox. There was no way for me to be comfortable. I took my bath, sat in bed for a while, got up and took other bath. This was repeated several times. I knew I might be disturbing other guests (not my husband, he is very good at sleeping) but having the hotel call for an ambulance to cart me away during the middle of the night would have been just as disruptive. I was close to that but I made it through the night and took my last pill at breakfast while listening to an English couple verbally trash the people in the room above them who ran water all night long. I was torn between crying or getting up and grossing them out by showing off my rash. My husband talked me out of either one and we went on to tour Monet’s house and garden.

From Giverny we had a 3hour drive to our rental house in a small town in
Normandy. I looked at the map and told my husband we were stopping to find a doctor in the last large city we would go through, Caen. Finally, we got to Caen and started looking for the tourist office or a large hotel. We figured either one could give us the name of an English speaking doctor. Caen has a ring road around it. It was heavily bombed during the war so it just is not built like other old French cities. We could not find the city center, the tourist office or a big hotel. Finally we found a hospital associated with the university. It is referred to as CHU.

We went in to the emergency room and I started explaining my problems with my limited French. Now I know that in
America a large portion of the population speaks only English. Usually in France or Italy even in small towns there is always someone with some knowledge of English besides their native language. CHU proved to be the exception. I went through my whole story in the best French that I could. The replies that I understood were that the doctor who is able to speak English does not work on Saturday and that I should just go back to the pharmacy for more drugs. When I protested about not wanting to continue to take the same drug, pointing in the insert to the line about not taking more than 5 days in a row the response was “Are these directions in Spanish?” When they were quite clearly written in Italian. I began to despair and realize I might have to create a scene. Somehow I must have looked desperate enough or flashed my nasty rash enough times that it was finally decided perhaps I should see a doctor. Mind you all of this taking place in the lobby of the emergency room.

After a short wait I was called to the admitting window to provide every form of identity and address that I had but no questions about medical history or current medication. Another wait and I made back into the examining area waiting room. The only way to describe it is like a three ring circus. There was a central waiting area with three groups of examining rooms off of it. The central waiting area was like a parking lot for gurneys with patients. I think the poor souls had been evaluated and were waiting for rooms in the hospital. There was no intercom or paging system. If someone in one room wanted someone else they just stepped out the room they were in and yelled. Except for one man in a lab coat (who rarely moved) it was impossible to tell staff, doctors or nurses from patients or family members. Everyone was dressed very casually as if they were going shopping or perhaps to an outdoor outing. After sitting there for a while I started to work out who was who. I was shocked when I realized that most of the women were doctors, nurses or students and were wearing the strappiest of sandals, one step above flip flops. Coming from a work culture that insists on closed toe shoes year round I was amazed.

After another wait, a nurse who spoke fairly good English came to take me to an examining room. While her English was great, she had as a backup a binder with the question written in French and the translation written in English right below it. She would read it to me in French and then in English. My answer was in a combination but we worked it out. She took blood, scraped my ugly rash and gave me a vial for urine collection. After we got all of the tests out of the way she offered to let me sit in this nice quiet examining room while I waited an hour for the test results. After seeing all those people on gurneys in the waiting area I felt it would be a little selfish to occupy such a nice private space when I really did not need it. Besides I would miss all the fun watching the shuffling of gurneys. I went back to the central waiting area. In the next hour I figured out that the one old guy who had run of the whole place was sort of a mascot or a repeat visitor who came in to dry out. He roamed in and out of rooms, chatted with the staff and one nurse brought him afternoon coffee. Periodically he would go outside to smoke and then come back. While he was running around patients on gurneys would come and go, be moved from one gurney to another or have their IV changed. It was not a very sensitive treatment of them and I am sure many Americans would be shocked.

Exactly an hour later my test results arrived. The doctor who had come to the outer waiting area to view my rash and decided that I should be admitted came out to discuss the results with me and although she did not use the term shingles she confirmed it was viral and would last a long time. She handed out 3 prescriptions. No discussion about current medications or preexisting conditions. We discussed that I could continue to drink wine in moderation and she gave me a letter to take to my doctor in the states. Then, she was hesitated but asked if I would consider letting her students see the rash. They must not get many cases of it. I agreed and we stepped into a room for a quick peek at the red oozing mass that had crept around half of my body.

Prescriptions in hand, off I went to collect my husband and face the discharge office. I was very concerned about this, 3 tests, at least 3 hours in the emergency room and a consult with a doctor. I figured I had run up at least a thousand dollar bill. Expenses like that will certainly cut into your travel fun. The discharge lady asked if I would want to file this with my insurance and I confirmed that I would. After much keying, printing and stamping she produced a bill for 77 Euros (around $70.00). I almost hugged her. We gave her a credit card. She directed us to a pharmacy that was still open on Saturday afternoon and off we went. At the pharmacy it took less than 5 minutes for the prescriptions to be filled. Again, no questions about other medications. Many copies of the receipts so I could file for insurance and a 100.00 Euro (90 to 100 Dollars) credit card charge then we were on the way.

We emailed our neighbor and she made a doctor’s appointment for me on our first full day back. My doctor confirmed it was shingles. The medication I had been give was the best I could have taken. She gave me a different type of pain reliever and laughed with me about the letter in French which we thinks says that I was seen by a doctor and that is it.

Back in the fall when I had started to plan this trip and began to put down deposits on our rental houses I got a cancellation insurance policy. (It just makes good sense when your Mom is 88 years old). During my long night in Giverny I looked over it and discovered that I had medical benefits. I decided to file with that company before taking the matter to my own health insurance company. I went online, downloaded the claim form, mailed it off with copies of the receipts and in two weeks time I had full reimbursement for all my medical expenses.

For your specific interest, please search the web for further information using Google .

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That's it for Wednesday, 5 April 2006: mercoledì, 5 aprile 2006

Ciao, Ben

Today’s quote is an Italian proverb, author unknown.

"Si salvi chi può."
"Every man for himself."

When you have a free moment or two, please read my wife's interesting and entertaining blog about our life in Italy with photographs:

Friends and Family in Italy

Going to Spain, read my new blog:

Info About, For or On Spain – a source of links About, For or On Spain for those individuals traveling or already living in Spain.


© Benjamin H. Licodo, 2005 - 2011, All Rights Reserved.

1 comment:

Barbara said...

We too have had good luck getting reimbursed by BS/BS for our Italina healthcare expenses, and we too fought an unexpected bout of shingles while on vacationin Prauge!

And just one note: at the current rate of exchange, €77 would equal about US$95