Visa to Ill: Sick in a Foreign Country

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T-minus five hours to Myanmar. I awoke at 5AM after a night of fever dreams, having sweat through everything. I emptied the entire contents of my body, again, and ran a cold shower. Standing in the dark, near tears, I steadied myself against the glass wall and leaned into the water. The only rational thought I could muster was "Will this get better before it gets worse?"

 I gently woke Emily and mumbled the dreaded words:
"I need to go to the hospital."

An Iron Stomach

I'd never heard of a "Travel Doctor"  before we arrived at our appointment on E 69th in NYC. I'd been to Mexico in my childhood, and thus believed myself qualified enough to deliver bad Montezuma's Revenge jokes during my stint in morning radio. That was the extent of my travels to anywhere health wasn't near-guaranteed.

Since insurance views preventative and curative treatment differently, and by differently I mean "we're not paying for this", I was a bit shocked at the length and cost of the pre-visit vaccination menu. There were viruses and diseases listed that could maim or murder me I'd never heard of, and all the sudden I was putting a sticker price on my life. This is where the advantages of a Travel Doctor come into play.

To break ice that could have remained unbroken if not for my awkwardness, I'd asked our Doctor how they came to be in this line of work, expecting an answer about traveling to third-world countries and observing their suffering.

"It found me. Someone told me about this opportunity and it was definitely less stressful than the ER," they said, "I haven't been to Southeast Asia before."

We worked through a book of the regions we were traveling to, dates of those travels and gauged the risks together. Fortunately, we were mostly sticking to populated areas that were less subject to rare but devastating viruses like Japanese Encephalitis, a cousin of West Nile. Eventually we had our list of vaccines together and were ready for our stabbing.

In our discussion of the major risks, I'd easily forgotten about the things we take for granted: clean drinking water and food-borne illnesses. We were told that different regions require different antibiotics, and that it's likely we'd encounter Traveller's Sickness (a.k.a. Traveller's Diarrhea) at some point. In my naivety, I smiled out the famous last words:

"I have an iron stomach." 

Don't drink the water

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After spending the first third of our trip in westernized countries, we were overly cautious about our first destination, Malaysia. We were urged to rely on bottled water throughout all stops in Asia. Easy enough, but since we're both research-addicted, I discovered it's typically fine to drink the water in Kuala Lumpur. We were staying in an apartment in a 37 story building, surely not everyone buys bottled water here.

Malayasia is impressively modern country in most places, and we made it through KL no problem after an adventurous street food tour and some apartment tap-water. I believe this is where I let down my guard. We arrived in Penang, a city lauded for its vast cuisine closely tied to its local heritage. I love Malaysian food by this point, and naturally thrilled to be there. When you're consuming local food and drink, whether on a food tour or at a cooking class, you have to be on guard for anything suspicious. Penang was not KL when it came to cleanliness, especially when staying in historic Georgetown.

I have no idea how I got sick, but I drank hotel tap water, consumed local drinks without questioning the origin of ice or base and I got sick directly after a cooking class. I do not want to discourage anyone from living the local life. Eat, drink and be merry, but for the love of your own health and sanity... DON'T DRINK THE WATER.

I'm Buying a Bidet When I Get Home

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Something was definitely up. After a few visits to the restroom, I assumed it was a small bout with diarrhea and this too shall pass. Then I got the chills. Again, I thought it was just my body trying to make sense of something. Less than 24 hours later I'd made up my mind that ok, yes, you probably have Traveller's Diarrhea. Here's where anecdotal evidence got into my head, and I may have under-reacted.

A traveller that had been to the region a few months before told us their bout cleared up in a day or two. In plenty of internet searching, if you have the right drugs (we had two prescriptions, Cipro and Azithromycin) and take them at first signs, everything will be fine in a couple of days. Around 24 hours after the incident started, I finally popped a zithro. This may have been too little too late, and that's due to my previous history of not giving a shit when I should pay attention to my body. Now I was giving all the shit my body can muster. Colors and consistencies I'd never imagined, all of which warning signs that something was truly amiss.

Our room was small and separated from the restroom by glass, and was frosted in strategically advantageous places, but let's agree that a glass "phone booth" isn't acoustically or olfactorily sound. Poor, sweet, innocent Emily. Every hour brought new horrors, and swiftly ushered in that stage of a relationship where these sights and sounds are not only commonplace, but analyzed and rated. I cannot overstate the importance of humor at this juncture, and how important the word "solid" had become to my psyche.

All the while I was forcing myself to eat, but my appetite was nil. I was slamming bottled water laced with Gatorade powder, but I couldn't stay hydrated at the rate liquids were leaving my body. I couldn't urinate, because my body had more entertaining uses for water at this point.

We debated the impact my health may have on our next destination, Myanmar, and decided to wait until the next morning, our planned departure, to make the call. When I drug myself out of that shower, I knew I wasn't going anywhere. Not only that, I'm going to the emergency room in a foreign country.

Surge Pricing

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Laughably, we thought Uber was the best choice to take me to the ER. Although they had a presence in Penang, finding an available car at 5 AM was a shot in the pre-sunset dark. Emily had to get on the horn with Malaysian 911, which is 999 but 112 on mobile specifically.

"Hello, what is your emergency?" the operator asked.

"My boyfriend needs an ambulance," Emily replied.

"Hello, what is your emergency?" the operator asked. Again.

"Hospital?" Emily tried. "Penang General?"

Thankfully that was enough information to transfer us to an operator at Penang General, the closest public hospital which also boasts four stars over 50 reviews on Google Maps. Again, our luck was out as they couldn't understand Emily. I grabbed the phone, pleading "English" until the voice on the other line changed. I was having trouble breathing at that point, likely anxiety, and things were starting to get scary.

We would have had the man at the hotel's front-desk assist, but his English was as good as our Malay. Basically there to make sure the place didn't burn down, which he did an absolutely fine job of. Finally, we reached someone who knew enough to get the basics out of us. At this point everything was a total comedy, and I faulted nobody for it. This is how it's supposed to go when you're thousands of miles from home, right?

Twenty minutes and an errant lap around the block later, the ambulance arrived and we were on our way to the ER.

Prognosis Negative

  Penanang General Hospital, photo courtesy of  Wikipedia

Penanang General Hospital, photo courtesy of Wikipedia

Outside of the hospital, I sat in a rickety wheelchair with my head in my hands, an absolute wreck. After some paperwork and passport scanning, I finally found myself face-to-face with a doctor... at least I hoped they were a doctor, because he had to have been the Malaysian Doogie Howser.

"He has a fever of 39.4," he said to Emily nonchalantly.

That would explain the chills, I'm sitting at just above freezing. So much for skipping winter. Thankfully Emily asked for a conversion to Fahrenheit which made more sense at 103 degrees. Not immediately dangerous, but not good for short-term comfort.

After moving through a few more circles of hell, including bloodletting and recitation of my body's recent sins, I was given a bed in an unmercifully warm room while they analyzed my vitals for a few more hours. All this time the specter of a lengthy hospital stay hung over our trip. It was not my finest moment, but I was glad I was at least moving forward on whatever evil had entered my body.

I managed to get a nap in while slurping delicious IV cocktails through my hand-straw, and was woken by two more young doctors to discuss my diagnosis: Traveller's Diarrhea... but maybe Cholera or Dengue Fever.

"Have your stools been milky or contain mucus?" one asked.

"I'm... I'm not sure what that would even look like," I said.

"Does your stool look like after rice has been soaked in water?" the other clarified.

"Oh... no, I don't think so," I said. So much for eating rice without this thought the rest of our TRIP THROUGH ASIA.

"We'd like you to get more blood tests in the next week to rule out the other possibilities. Will you be around Penang?" the lead doctor asked.

"I was supposed to go Myanmar in... about an hour," I said, knowing we wouldn't make that flight.

"Ok... " but something in his expression said "Please don't go to Myanmar in this state."

General Malays

Using phrases like "a few more circles of hell" makes it seem like this was the worst experience of my life, and it was pretty harsh. In actuality, I owe a lot to Malaysia's medical professionals, especially in that I didn't owe them a lot of ringgets.

I visited a public hospital, including an ambulance ride and medication, and visited two more private clinics to receive blood tests and additional meds. In total I paid less than $100 USD total to receive outstanding care. This wasn't because of a favorable exchange rate, it's because Malaysia doesn't believe in bankrupting people to receive medical care. In fact, most citizens can receive complete care for as little as $1, depending on where they choose to visit for their ailment. At no point did I have to file a claim with travel insurance or my primary provider.

Aside from the monetary portion, which is obviously a big deal for an American, the doctors and staff that cared for me were genuine, gentle people who love helping no matter the nationality. Malaysians are incredibly kind people, who daily set aside religious and ethnic differences to make their country great. Our hotel hosts bent over backwards to make sure I was comfortable, and asked about me every chance they got. Even though the potential diagnoses were scary at times (Dengue kills), I was always assured with a smile that I'll be back to normal soon.

We decided to pass on Myanmar completely, booked five days to recover on the resort island of Langkawi, then rerouted to Singapore for a few days. It was day nine after the initial incident that life was "solid" again, and we cheekily celebrated with a bowl of spicy tonkatsu ramen.

I'll never take my health for granted again. When my 33-year-old body speaks, it's time to listen.

What We Learned

Host countries and vendors do have tourists' best interests in mind, and make their best efforts to mitigate risks of food and water-borne illness. However, we've learned new precautions, techniques and remedies that we feel important to share after our travels through Southeast Asia.

Food

  • You'll see a lot of raw meats and produce that have been resting, on or off ice, for lengths of time. We've learned on our market tours that these goods are processed and move quickly enough to avoid contamination.
  • Some prepared foods also rest, so it's in your best interest to look out for stalls or vendors with high traffic, or to request something freshly cooked. If it feels sketchy, don't risk it. This may be where the phrase "go with your gut" originated.
  • We highly recommend food tours and cooking classes! Guides and teachers know their local markets, food vendors and dishes very well. Some food tours are more adventurous and local, which is something we actively seek out, and with that comes a bit more risk.

Water & Beverages

  • Liquid water, including non-brewed beverages such as limeades, are suspect unless you see them come out of a sealed container.
  • At restaurants and street cafes, look for ice that's cylindrical with a hole in the center, which indicates it's commercially processed and produced.
  • Definitely minimize tap water's contact with your innards, including teeth-brushing if you want to be extra careful.
  • Bottled water is inexpensive, and there's usually a convenience store (7-eleven is everywhere) within blocks of your stay. Stock up and stay as hydrated as you can.

Health

Note: We are not medical professionals, so take this advice as you see fit. Most of this info or medication we received directly from doctors/pharmacists.

  • While Immodium or anti-diarrheals may seem like a good idea to go about your day/trip, your body needs to evacuate toxins, often violently, for a reason. Do not interfere with nature's processes.
  • Activated charcoal pills - I'd never heard of them, but they're basically Pepto-Bismol in a less flamboyant form. The charcoal serves to soak up the toxins in your gastro-system, which can speed up recovery from infection. Unfortunately they can also soak up beneficial prescription medications, so give ample time for them to process before moving to charcoal.
  • Oral rehydration packets / salts - We brought Gatorade powder with us, but quickly switched to these inexpensive, widely-sold packets to quickly replenish electrolytes after sickness or a day of sweating our asses off.
  • EAT. If you're ill and don't have an appetite, suck it up and consume the simplest foods you can. Broths, crackers/breads and fruits helped me through my ordeal. I even visited a McDonalds because I wanted something familiar-ish to jump start an appetite, rather than to not eat.
  • You need rest days, especially if you're ill. We skipped an entire country due to the timing of my illness, and I'm thankful for that ability to rest and recover. You're not going to have a great time in (insert next country here) if you can't leave your room or don't trust you'll receive adequate care.

Addendum

Rose George's video above explains how many things we take for granted in the modern world are daily struggles for millions. It's easy to make light of my own situation, but I learned that diarrhea kills 2,195 children per day

Poor sanitation conditions, unsafe water sources and lack of proper hygiene kill hundreds of thousands a year by spreading diarrheal germs and rotavirus. Water.org mentions that 1 in 10 people lack access to safe water and 1 in 3 lack access to a toilet.

We wish you happy and healthy travels, and happy and healthy lives for those who live in unsanitary conditions largely out of their control.