When people learn that I’ve been living abroad in one form or another for the past three years, the question that most often comes up – besides how many pairs of shoes I pack – is what I do when I get sick.
Where do you fill your prescriptions?
How do you keep up with preventative care?
How much does it cost to see a doctor away from home?
For me, the answers are relatively simple: I don’t have any prescription medications to worry about; I schedule annual visits when I am home on vacation; the one time I did see a doctor for a minor issue abroad, it cost me next to nothing.
Now that I am employed in Germany and have universal health care, the process is even easier. When I need to see a doctor, I make an appointment the same way I would in the States… the only differences being I have to do it in German and at the end, I don’t pay a thing.
The short answer: I’ve been lucky that I’m healthy.
But everyone’s luck runs out at some point and my clean bill of health came to a screeching halt about two weeks ago.
It started as a nagging little pain in the outer corner of my right eye. Just a pick, really. That was Thursday evening. A day went by before it started to hurt when I looked down. By Saturday afternoon, it was sensitive to light and my eye had turned a cranky pink. Even still, it wasn’t all that bad and I decided to ignore it.
I didn’t know what was wrong exactly, but my best guess was that I had a scratch on my cornea. That happened once before when my ex-boyfriend accidentally hit me in the face with one of his dreadlocks. That might sound kind of sexy, so allow me to elaborate: It was Thanksgiving and he was pretending to be a turkey. One overzealous shake of his tailfeather was all it took to ruin my holiday weekend.
I never got treated for that injury. WebMD confirmed my symptoms and, as expected, it went away on its own about a week later. My plan was to wait this one out too, but then fate intervened while we were on a day trip to Verona. Johann, who had been suffering from a head cold for two weeks, finally agreed to visit a pharmacy. The man behind the counter took one look at his runny nose and watery eyes and said what I had been telling Johann all along: It’s allergies.
Seeing as how this man knew what was what, I decided to ask him if he had anything to help with the pain in my eye.
He squinted at my face from across the counter and shook his head. “That’s an infection.”
I did a double take. “Really?” I asked. “It doesn’t feel like an infection.”
“We call it conjunctivitis,” he continued.
“We call it conjunctivitis too,” I said. And I’m sorry to say that I had that once before as an adult too – whether from the 14th St. YMCA, an Amtrak train, changing my nephew’s diaper or my own goddamn stupidity. Regardless, what was happening deep in my skull didn’t feel like pink eye at all. It felt more like it had been scraped by a dreadlock, which was not a point of comparison that an Italian pharmacist would understand.
In the end, the pharmacist gave me OTC drops that would lubricate and flush my eye. If it got worse, he told me to come back and pick up an antibiotic. And with that, Johann and I went about the rest of our day, exploring Verona, a city whose population was largely wiped out by the plague several hundred years prior. We should have taken that as a sign.
The next morning, back in Venice, Johann woke up with a ridiculous-looking rash around his waist. Meanwhile, in the bathroom, I had my face pressed close to the mirror to inspect the puss that was now running out of my eye.
“I’m allergic to that medicine!” Johann yelled from the hallway as he lifted his shirt up to his neck.
“I don’t think that’s possible,” I replied. “How can you be allergic to allergy medicine?”
He ignored me as he swayed his naked belly in the world’s least sexy hula dance.
“Maybe it was that cold capsule you gave me,” he admitted. “I got this once before when I took a cold medicine. I’m allergic to that for sure.”
I whipped my head around so fast my eye practically slipped out of its slimy socket.
“Allergic to what?” I asked.
He shrugged, as though this was an unimportant detail. “Whatever I took yesterday,” he answered.
“You need to know these things,” I said, turning back to the mirror. “So that you don’t die.” And, more importantly, so that I’m not the one who accidentally kills him with a DayQuil tablet.
“I guess it is an infection,” I complained, turning my attention back to the mirror.
“Look at this rash!” Johann insisted.
“I can’t,” I said. “I only have one eye right now.”
“It doesn’t hurt,” he continued, pinching his own stomach. “So I think it’s fine.”
“Wonderful,” I said, squinting at the address of an urgent care clinic in Venice with my non-diseased eye.
“I’m going to go to class now,” he said.
“I’m going to the urgent care clinic,” I replied.
And with that, we both left the house, taking extra care to cover up those parts of our bodies that would most offend the great city of Venice and all its beauty.
I’ve never met an urgent care clinic I didn’t like, but that was before Venice. This one was a bust. Even though it was marketed as a service for tourists, the women working there did not speak English, nor did they seem to understand my pantomime for “eye infection,” which was basically just me pointing at my clearly infected eye. Instead, one of them loaded Google Translate on an ancient desktop computer and typed, “You need to go to the hospital.”
“That seems extreme,” I wrote back. “I think it’s an infection.”
“It’s an infection,” she agreed. “But I don’t know the origin. You need to see a specialist.”
This was all very confusing considering that just the day before all I needed to see was a pharmacist. I had come to talk to a doctor simply as a precaution, in case it was something more serious. If she could tell it was an infection, why the reluctance to write me a prescription? Isn’t this what a general practitioner does?
I begrudgingly accepted a map to the local Ospedale, where I fully expected to give a room full of Italian doctors a good laugh with my non-emergency. But before I got anywhere near the hospital, I passed a pharmacy and decided to try my luck there. The woman behind the counter happened to agree with me.
“You have an eye infection,” she said. “Why would this doctor send you to the hospital?”
“It seemed absurd,” I said.
“What’s absurd is that she didn’t write you a prescription,” the woman replied.
The pharmacist disappeared into the back room and returned with a small bottle of eyedrops and a package of medicated wipes – the total cost of which was $18. Two drops and 8 hours later, I was pretty much cured. The goo had cleared, the redness was gone and the sun no longer made me wince. Most importantly, the pain had disappeared. I could look up, down, left and right. I celebrated with a book and a Spritz and one hour of Vitamin D exposure.
That bliss lasted for about two days. Then, much like the week before, the corner of my eye began to nag again. Slowly, the pain crept back in. Oddly, it seemed to intensify whenever I used the antibiotic drops. I continued taking the dosage as prescribed, assuming that the medication was just causing dry eye and it would all go away once I finished the prescription.
But then, by Saturday morning, my eye started to look bad again. It was red and irritated, wet and runny. Johann and I were about to get on a train to Milan and I wasn’t sure that I should go. At the same time, I didn’t see the point in staying in Venice. There wasn’t a doctor who could see me until Monday. If it got bad enough that I had to visit a hospital, then I could take that step in Milan. Besides, if I had to stay inside and rest then wouldn’t a four-star hotel be a nicer place to pass the day than my budget Airbnb?
We got on the train, my eye throbbing the whole way. I closed it and it ached. I opened it and it picked. The more I moved, the worse it felt. I don’t know if you know this, but it is next to impossible not to move your eye, even when it’s closed.
Johann, his rash mostly healed by this point, refused to let some bacteria hog the spotlight. By the end of the weekend he had sacrificed a considerable portion of his thumb nail to a key chain and then walked directly into a chandelier. For two straight days in Milan, it was like the blind leading the dumb.
On Monday morning, I did a Google search for local ophthalmologists. I found one whose office was a 12-minute walk away from our apartment. I showed up shortly after the office opened and asked to make an appointment. The doctor saw me within an hour. He did a complete eye exam with a fancy looking microscope, put some dilating drops in and did it all again. He and his assistant both spoke English, though they really seemed to get a kick out of testing my comprehension of basic commands in Italian. For once, Duolingo prepared me well: C’è latte nei miei occhi/There is milk in my eye. I could have worked that in if I wanted to.
Long story short, the doctor told me that I didn’t have an eye infection – at least not anymore. Apparently, I had a deep inflammation of several parts of the eye, which is a condition known as uveitis. He prescribed me four different drops and made a follow up appointment for three days later.
If uveitis is a serious condition, I really don’t know. He didn’t say and I didn’t ask. I also put myself on a strict WebMD diet, granting myself permission to only read the summary page and the list of symptoms online to make sure it all lined up. I Googled the medications to see what each of them did and that was that. If a tumor is causing my eye to be squeezed out of my face like ketchup from a bottle, I don’t want to know about it right now. If I’m on the road to blindness, I’d rather not have a map. Ignorance is bliss – as is four different anti-inflammatory medications after you’ve been in significant pain for a week.
One of the things that makes getting better a little bit easier is knowing that I can afford the treatment. Here in Venice, I paid €152 for the appointment at the ophthalmologist. The medications cost anywhere from €10-21, for a combined cost of €59. In total, a same-day specialist visit plus four prescription medications cost €211, or about $240.
That’s not nothing, of course – especially when you consider if I had gone to the doctor in Germany the cost would have been $0, or close to it. But when compared to the American system, it’s actually a pretty good deal. When I lived in New York and had a fairly robust insurance plan, I would have paid $40 for a specialist visit. Then, I would have paid 20% of whatever the doctor billed my insurer. I have no idea what that amount would be in this case, but I would expect it to be around $200, at a minimum. Over at the pharmacy, each prescription would cost $25 to fill, assuming there’s a generic available. If not, the brand name drug would likely be $35 or even $50. Best case scenario, I would have paid $100 for the medicine. Long story short, the same visit – assuming I could even see a doctor the same day – would run me about $340, give or take in the States. Put another way, it would have cost me more to see a doctor in my own country with a corporate insurance plan than it did for me to see one as a foreigner with no insurance in Italy.
But tell me more about that world class system we have and how great it works. Tell me all about it. My ears are working just fine.
For some people the very thought of having to find a doctor while traveling is a risk not worth taking. “That’s my biggest fear – to get sick away from home,” they tell me. “I can’t imagine!”
The dread in their voices makes me think of life-threatening viruses or catastrophic injuries: Ebola. Malaria. Loss of limb. Anything that requires a blood transfusion. But what I think they’re actually talking about is something far less scary – some easily treatable, run of the mill illness that has to be endured without the comfort of a family doctor who speaks English without an accent.
I’m here to tell you that you don’t have to worry about stuff like that. Getting treated for a sinus infection or pink eye or a UTI is often easier and simpler abroad than at home. Don’t let that stop you from getting on a plane.
In many countries, pharmacists have the authority to dispense antibiotics and other prescription medications to people who wander in off the street. I doubt they’ll give you any of the fun stuff, like painkillers or erection makers, but they are usually pretty agreeable if all you want is something to unclog your sinus cavity. If they refuse, most major cities have urgent care clinics or doctors who cater exclusively to tourists. They’re affordable and accessible, just like at home. The process is the same too, which is to say: You find one and you go; you show up and you wait; you get treated and you pay. True, there may be a language barrier or other communication issues, but considering that you’re reading this blog it’s pretty clear that you at least understand English. Even if the doctor doesn’t speak a lick of that (which is rare, honestly), then you’ll hardly be the first person to try. They will have a Google Translate page queued up and ready to go before you can say, “explosive diarrhea.”
It may be a little bit of extra legwork, sure – but visiting a health clinic in France shouldn’t be the biggest fear you have in life. In fact, I’d worry more about getting sick at home and having to pay the bills.
As a person who frequently has to visit doctors these days, I’ve been dreaming about leaving the US more and more…
Also I’m glad you’re feeling better!
Oh I’m sorry. I fully support a decision to up and move to Sweden… we could be neighbours.
Our exchange students regularly get expensive wake up calls when experiencing our US health care “system.” Our girl from Spain fell and thought she broke her ankle (although nurse who was with her at the time was pretty sure it was only sprained), and insisted on going to the doctor. After insurance her bill for x-rays (confirming the sprain) came to $200. Another girl from Sweden was diagnosed with type I diabetes while here. Her out of pocket expense for insulin, after insurance, will be $1,200/month and they wouldn’t pay for for an additional blood monitor so she can have one at school and at home. In Sweden, all of that would be free, for her and for any US student we might have living there for the year.
Ugh. On behalf of America, I apologise to them. I don’t know their situations, obviously, but I feel like it’s reasonable to see how medical bills can derail one’s education… either you have the extra 1200/month or you don’t. You pay it and stay in, or you have to drop out. It’s adding insult to injury, quite literally.
You’re a superhero!!!!
Oh I don’t know about that… a supernova, maybe :P
You are already covered for emergency medical care in another EU country – in some countries you need to apply for a separate European Health Insurance Card (I live in Spain, and that’s the way we do it here), but apparently it’s included on your normal card in Germany: “The European Health Insurance Card (Europäische Krankenversicherungskarte) allows all legal residents of Germany to benefit from emergency medical treatment and care when temporarily elsewhere in the EEA. All German residents must have health insurance and the EHIC is actually part of the health insurance card (Gesundheitskarte). The EHIC information can be found on the back of the insurance card.”
Wow – that’s great to know, thank you! I totally was not aware of that, though I did notice that Johann and my health insurance cards have the same back, which made me wonder if I was eligible for coverage cross the EU the same way he was. In all seriousness though, I still wouldn’t have gone to the emergency room for a case of pink eye (three different medical professionals said that’s what it was – why would a GP at the hospital say otherwise? that’s the kind of thing that makes the US system such a GD cluster) but I certainly won’t let it stop me in the case of an actual emergency.
Again, thank you for sharing… and thanks for reading too!
I’m sorry to hear about your eye! Just reading about it is giving me sympathy pains in my own eye (but that might be the hypochondria talking). I hope the anti-inflammatory drops have helped and you’re back in good condition soon!
Yup. Got strep throat while travelling in Malaysia, the hostel gave the address of the nearest clinic, was only about 20 minutes in the waiting room, and visit plus antibiotics and throat lozenges cost about $30. Spent a perfectly good tourist day in bed after that but it was worth it to no longer feel like death warmed over.
yep, I hear you. and I feel you on “wasting” a day. but I’m glad you took care of it. hopefully everyone took a mental note when you told them how you fixed yourself (with the help of a doctor and some lozenges, of course)
I’m thinking that part of the ‘terror’ most people exhibit about being ‘stranded abroad and sick” is the idea that only an American doctor would have the savvy to distinguish one illness from another.
It’s a very jingoistic approach, and a very ignorant one; as you say, most doctors/clinics/health professionals speak English, and they are as qualified as our doctors. Even more.
I think we still are wrapped around the idea that Europe is just rising out of the Middle Ages and use leeches and bleeding as standard procedures.
And yeah, Im glad you got that straightened out. Scary stuff, when your eyes start turning on you.
I think you are exactly right. We think the US is the gold standard in medicine all around… for serious illness, it may be. I really couldn’t say. But for strep throat and pink eye? Yeah, I think most doctors can handle it.
Thanks for reading… I’m glad I’m on the mend too. I’m hoping I can stop taking the medication next week… because right now the side effects (blurry vision and sensitivity to light) are so annoying it’s making me forget about how bad the pain was to begin with. Always a good sign when your body wants to stop taking the medicine. :)
We live in Korea right now & I had to take my daughter to the dr for bronchitis. The appointment, chest x Ray & a ridiculous amount of meds we didn’t really need cost $40. I dread going back to the US.
yep. it’s the same story every time I go and yet I just can’t seem to get over it… same quality of care, delivered more quickly at a fraction of the cost. what’s the downside again? I also dread having to go back to the US system… here’s to hoping we see some change in our lifetime!
YES! I get so impatient with people telling me America has a great health care system (which, frankly, happens less and less). The year we lived in France, we paid 20 euros for a drs visit (40 whole entire minutes with the actual dr, chatting about America’s role in WW2) for our 8 year old, and then 22 for 4 prescriptions. Admittedly this was in 2004 but still! That was without health insurance, and in the US at that time would have been $80 for 10 minutes with the dr. plus probably another $60 minimum for the meds.
And I loved living overseas and getting antibiotics, etc, as needed from a pharmacist. So much simpler. In parts of Africa, you can get pretty much anything without a prescription, just FYI.
So true! Here’s to hoping things can be improved!
Thanks for reading!
N