Health Care Abroad

[virginia boy]

I have been thinking about health care while traveling. I hope that the following info is not so personal so as to be in bad taste; but, I don't know how else to get an answer to my question without divulging a little personal info.
The VA has determined that I have a 100%, service connected, compensable, disability and so as a result I recieve my healthcare and all my medication from the veterans affairs medical center (VAMC) here in Wash DC free of charge. As a consequence I don't have private health insurance. The VA claims that if I need medical treatment I may use the VA facilities in US territories (puerto rico, american samoa,phillipines) or in an emergency use whatever facilities are available and afterward file a claim for reimbursement of med costs. Has anyone had any experience with the VA and getting treated overseas? I'm not sure that I trust them to not renege on payment. Is it possible to have non-narcotic medications sent to various places in the world and be assured of recieving them? I am hoping that there are some vets out there that can help. Feel free to private message if you wish.
Aside from VA healthcare, how do most people deal with healthcare abroad and is there a website or blog or what have you that I can go to for information?
How complicated are the first aid kits long distance cruisers have aboard. (sutures? splints? meds?) thanks, Eric

[captmick39]

Can't help You that much w/the VA(& not sure Who could short of the joint chiefs?) ;

Can tell You when You head to the third world hospitals can drop all the way down to GP-Medium's for accomedations.

My Dad, w/a new bride was on Vacation in Jamaica posing for a camera & was bitten by a rabid dog. After the confirmation they started the battery of injections...he didn't get rabies....He DID get HepC off the Hospital's bad needles. About 12 yrs ago at death's door (back here in the states) his ins.(NOT VA) sprung for 1 of the first US based Liver Transpants. It took & he's still kicking. After 2 tours in Korea & 3 in Vietman, in the end the closest he ever came to death was compliments of unsanitary practices in Jamaica (& it's still a far cry up from the bottom of the barrel world wide).

As for shipping meds, that can happen, straight to embassy's/consolates. UPS & Fedex deliver to their door, You'd just need a very understanding MD here & a friend to pick up & ship?

As for First Aid Kits, we grabbed a battalion Medic's bag, Milsurp. New, complete with everything. You can't do surgery, You can rapidly splint broken bones, close serious wounds (sutures and stitches); the inventory is extensive and we took a MOP Suit Bag sling & attached to same so it's a "small suitcase w/a shoulder sling" kept right next to go bags for abandoning as 406 epirb & liferaft are automatic. 1 thing to do is buy qt. & gal. freezer bags, repackage everything to be water/air tight inside & it's life expectancy is abt. 5yrs on non-perishables(bandages, etc.).
Not a cheap investment, goes even w/friends on deliveries, priceless when needed. It ISN'T a hospital visit; it Is the next best thing.

Rule #1 when hours/days/wk or more from the ER...try Your best to never do anything stupid.
Rule #2 when You or another forgets rule #1, evacuate the wound, get it really really clean, stop the bleeding, bandage, & keep it clean. Change bandages at LEAST daily...2x minimum if like now, summer, hot & sweaty.
It's also best to get CPR & Red Cross Advance First Aid Certified (at very least) before heading off to "abroad".

HTH,
-Mick

[virginia boy]

I'm sorry to hear about your Dad's hep C and resultant liver transplant. What a blessing that he has been able to survive for 12 years after his transplant! I take meds for a different reason although it is imperative that I take them every day. I was thinking that I may not be able to stay away for long periods so I'm glad to hear about sending meds to the embassy. thanks for your help. Maybe this trip is actually doable!

[captmick39]

VirginiaBoy,

I'd pass along the condolences if I weren't concerned about getting punched out for having shared the info. "Live"?! -> He's still a tough old bird & can kick Your & my butts simultaneously(at 70)...runs 3 miles & works out daily, benches about 250lbs & U get the picture. Can't speak for You but I smoke, drink, cuss, (used to chase wild women, a wife put the kabosh on that), & am far less "healthy." He biotchs 'bout the daily anti-rejection drugs (2x daily) & other than that You'd never know.
GOD Help the "mugger(s)" who take him for a "little old man"/victim.
They will be (as in he packs concealed 2 boot).
On to Your concerns:

IF this is Your first extended cruise offshore/abroad, a couple suggestions. Do a week or two island/coast hopping HERE. Called a "shakedown", gives You a good feel for the things You'll need more & less of, so You can stuff & unload accordingly. Works the "bugs" out of what You THOUGHT it might be like vs. "reality". Point being:

Proper
Prior
Planning
Prevents
Piss
Poor
Performance

have a "better half" who requires multiple 2x daily meds so can relate. Getting a 90 day supply is usually just a matter of ASKING and $$$. Getting a six month supply again usually (depending on the meds) just depends on the MD, & the Insurance You have. If You have the $$ for an extended cruise (they aren't free), You should be able to muster the funds for a 6 mo. setup. Longer than that requires review of the 7P's above & networking w/other cruisers (like here).

Dad was Sgt.ofTheGuard, Embassy Duty(USMC), learned much in youth as to services available to folks outside the fence in a "far away place" needing assistance. They almost ALWAYS have an MD on staff, so You can get a free checkup while picking up Your "special delivery" & have him/her communicate w/Your stateside MD, for free. ALWAYS KNOW the Embassy/Consolate Addresses & local #'s are when in another country's jurisdiction. They can save Your bacon(boat&self) in a pinch.

If a BLIND Man, & a 17 year old can solo Circumnavigate, You can do an extended cruise w/o availability to meds preventing same, betcha.

Don't let "red tape" stand in the way of Your dreams/plans/goals.
Get out the scissors!
HTH,
-Mick

[Kaya 09]

Having survived a 6 day crossing with a crushed pinkie that occured on day 2 (compound open wound fracture), I was never so glad that we spent the dollars on a well equipped medicine kit. Four days after the incident, when I finally managed to visit an emergency room, the Dr's were amazed at how well we were able to set the finger. Luckily, after visiting an orthopedic surgeon, while there was nothing he could do to improve my finger, he did give us a health script for cepro and pain meds. Niether of which i needed at the moment, both of which I could have used at the time of incident. Find a dr. explain your circumstances, and make sure this is part of your 'untie the lines' provisioning!

[virginia boy]

WOW! A compound fracture is serious bidness. Infection is a real possibility especially under those circumstances. I had a cut across my knuckles that almost killed me due to a staph infection. Only took a few days to become life threatening. I suppose a broad spectrum antibiotic would be useful also.
Thanks, Eric

[captmick39]

Eric,
the problem is if not the RIGHT antibiotic (know You said broad spectrum, & that's right, just not enough), it might not help much, or at all.

WebMD...a beautiful thing. Wireless access either via cell or satellite even prettier. Emailing Your doc takes minutes (though typing w/a compound fractured pinky would be a real bear), we carry SERIOUS pain meds, cipro, flagyl, doxicycline, & the usual baking soda, vinegar, aloe, peroxide, alcohol, iodine, advil, aspirin, ibuprophen, pain meds of codone, oxycontin, & injectable morphine (wife's an RN, although now in "mgmt" due to medical issues, for which everything above aside 1 antibiotic for me has been prescribed...they work on ANYBODY in a pinch), & in a humid/hot environment they need to stay in a cool dry environment(like a refrigerator just not Frozen), we again keep all in 1-1gal. freezer/ziplock baggie...You can grab 'em quick that way. Life Fire Extinguishers, it can matter.

Previously discussed compound fracture & infection could of & probably SHOULD Have been dealt with air flight medivac, easily accomplished by paying out painter w/victim in dinghy, 50-100' behind the vessel laying off the wind(Choppers aren't real keen on rigging for their basket to get hung up on...they don't like swimming). Know when to call for help. Don't think twice when the time arrives. You'll remember...the brain doesn't work as well w/a fever, & infections guarantee those. The longer You wait, we all know the rest of that story.

When it comes to offshore,
Baden Powell (founder of the Boy Scouts) got it right;
"BE Prepared".
HTH, again,
-Mick

[memryqlts]

My husband and I are planning on cruising the the Bahamas or Florida this winter. I currently have insurance, but COBRA is too expensive. Does anyone have any recommendations for other types of insurance policies and that are semi reasonable? Is there an insurance company anyone could recommend we check out? Thank you

Memryqlts
S/V Changes

[captmick39]

Originally Posted by memryqlts

My husband and I are planning on cruising the the Bahamas or Florida this winter. I currently have insurance, but COBRA is too expensive. Does anyone have any recommendations for other types of insurance policies and that are semi reasonable? Is there an insurance company anyone could recommend we check out? Thank you

Memryqlts
S/V Changes

go to any of the search engines,
type in
"health insurance quote"
hit enter...
get ready to do lots of reading.

It's out there, the less it covers, the cheaper it is.
(duh)

[Kaya 09]

Capt Mick, FYI - Kaya is a female . I would hardly call an injury that was able to be splinted/bandaged immediately worthy of calling in a medvac! Further, as we were in the Gulf of Mexico - a quick email to web md was not an option, although this is an excellent service (we had just started cruising and had not learned to use the single side band to send emails). So - we were left to our own devices and having a top of the line medicine kit was definietly worth the investment. You are correct in search for health coverage. If you type in your personal data, they will call you. The higher your deductible, the better (ie 10k is a good start. You really only need the coverage for the emergency or serious illness coverage. Anything less can be treated locally in the islands).

Va. Boy - there is also another transport service called DAN (?) it is provided through the scuba diving services and it is an insurance that provides discounted transportation for emergency medical services. My husband and I are back in the states at the moment and plan to head south again this fall. We will probably not be back in the states for a couple of years. I will certainly have this coverage prior to leaving as air transport services can cost a fortune.

[Kaya 09]

Duh, meant no disrespect Virgina Boy! I was abbreviating the state name and did not think about the references to the VA Hospital services. Sorry.

[Cheechako]

Our doctor very willingly prescribed a huge amount of prescriptions before we left including pretty much the most potent pain meds as well a antibiotics. The only problem is that many thins go out of date in a year or less... so it's a bit of a problem.

[donradcliffe]

Most meds are still good long past their use by date, which is set by the drug companies in collusion with the FDA. One big exception is doxycycline and its derivatives, which can go toxic.

Antibiotics are available in most of the world without prescription and cheaper than the US. Non prescription stuff like ibuprofen, tylenol, vitamins and supplements are way cheaper at Walmart, so stock up with the big bottles. Lipitor seems to be cheapest from the Canadian pharmacies.

Get the heavy pain meds from whoever in the family just died of cancer--"so sorry to hear about Uncle Mark, what did you do with his pills??"

[Kaya 09]

Donradcliffe,
You are correct. The Doc that prescribed our antibiotics and pain meds is also a sailor. Basically, his instruction was to keep it out of UV rays and meds he prescribed (cipro and vicoden), even after 5 years, only loose about 15% efficiency. As I trust him, my meds will stay with me for 5 years past the issue date.

[hellosailor]

Something to remember is a benefit of being the captain and master of a US-documented vessel. WIth that status and proof in wiriting, you can go to a dispensary pharmacy and they are allowed to issue a full set of rx-only meds to the vessel for use outside of US waters.

(I think "dispensary pharmacy" is the correct word, your ordinary corner drug store can't do it.)

Similarly, if you have a local doctor who has known you and dealt with you over the years--he can just issue the scrips as needed. There are some excellent books on wilderness medicine and bluewater medicine that have suggestions. Among them, silvadene type cream for burns, rather than antibiotics.

But for the life of me...I can't figure out why any commercial grade trauma/aid kit costs so bloody damned much, while anything that says "first aid" (which should be a separate kit) only is stuff with 150 bandaids and four types of ache pills....