Scoop: I've Fallen in a Foreign Country and I Can't Get Up!

by Mary Hollendoner
* Don't forget to check out the special travel insurance section

Picture it…. You take off to Asia for a year of backpacking and adventure full of excitement and exuberance. You take a bus out of Bangkok, your heart in your throat each time the suicidal driver passes on a blind bend and honks at oncoming traffic as they "get in his way." Turning one blind bend an oncoming truck doesn't swerve out of the way and the next thing you know you're lying under a pile of twisted metal amidst the screaming, crying and shouting of foreign voices. You are injured, alone, don't speak the language, and have no idea what the medical procedures in this country are like. What do you do?

OK, so you don't plan on this happening to you on your next trip adventuring around the world, but you never know what might happen. And that's the point of learning about safety abroad before you actually go. Let my experiences be a lesson in what to do, what not to do, and how to be as safe as possible abroad.

I got to Thailand in January to start a year of exploration in Asia. I knew absolutely nothing about Asia and didn't open my guidebook until I heard the pilot announcing we were about to land in Bangkok. I eventually made it to the infamous Khao San Road (where it seems they have more Internet connections than Silicon Valley), and found myself a room. A few days later I was on the bus to Krabi province in the South and then on a boat to Ton Sai - an internationally renowned rock climbing destination.

The sun was just setting at the time of my accident. I'd just finished climbing a 20-foot vertical rock face when my climbing partner let the belay rope holding me slip from his grasp, and suddenly I fell to the ground below. On landing, I broke my back. In excruciating pain, I discovered the hard way that there is no emergency rescue service in the area. I found out later that the local hospital was more like a do-it-yourself outfit than a real emergency ward anyway. My climbing partner and I were the only two people left at the cliff, but after my fall people came running up the trail to help, having heard the huge crashing sound of my body falling from the cliff. Imagine finding yourself lying on the ground in the dark with a pain a thousand times worse than anything you've ever felt burning inside your back. You know there is a significant chance you are, or will be, paralyzed and therefore are desperately staying conscious to ensure you are not moved at all by the many people milling around you. It's nerve-racking that there is no official sounding medical voice giving orders and clearing the area for a rescue. In fact, you hear your climbing buddies arguing about what to do with you and how to get you out. "This is not a joke," you want to shout, "this is fucking serious! Where the hell is the ambulance and helicopter?"

I don't know about you, but I had always imagined a very different picture if I were ever to have a serious accident. There would be an ambulance crew on the scene in minutes, rushing around injecting me with drugs and plugging me into machines and doing everything correctly during those precious first moments and then whisking me off to a hospital. However, when traveling in foreign countries, you cannot expect this and must be prepared to take care of yourself or your traveling companions on your own. Ideally you would research the medical facilities and emergency rescue procedure of every area of every country you were going to visit, but of course this is unrealistic if you are traveling for a year and visiting several different countries, as I was. Therefore, my most important advice to you is simple: be prepared to get yourself out of scrapes without outside help. Of course, I hadn't read the details of my insurance contract, only made sure they covered Thailand and rock climbing (many insurance companies don't cover high risk activities.) I had no idea what expenses they would cover and which services they offered me. I was incredibly lucky to have stumbled across a wonderful insurance company which had me transferred to a better hospital in nearby Phuket and paid for all successive medical and travel costs. I highly recommend that you do not travel without insurance. Craig Robinson of Global Health Insurance, who has been in the travel insurance business for many years, insists "No matter what your travel plans are - make sure you are adequately covered." I can say from personal experience that if you break your back or encounter any other disaster, it's primarily up to you and your friends to figure out how to safely transport you to the nearest hospital, and what to do upon arrival. And you better have a damn good insurance company to back you up!

From the second that I hit the ground the thought of paralysis entered my mind. I immediately instructed my climbing partner to support my head and neck, as I had been taught only a few months earlier in a wilderness emergency first aid course. Many of the people on the scene had taken EMT (Emergency Medical Technician) courses or other similar wilderness first aid classes from their country. I sincerely believe that had this not been the case it is most likely that I would be paralyzed now (Indeed the Western doctors I eventually saw could not believe I was not paralyzed with the injury I had sustained and without a professional rescue from the location of the accident). My partner meticulously constructed a strong backboard out of bamboo and wood and climbing gear. This was my vehicle to safe transport, without which it would have been absolutely impossible to get me to a road without bending my back and paralyzing me. I cannot stress enough the importance of knowing emergency first aid yourself if you will be in an area unreachable by doctors.

Both my climbing partner and I had prepared first aid kits for our travels around Asia, but carelessly had not brought them with us on the day of the accident! Luckily, as I lay in the most excruciating pain I have ever felt, a girl seemingly sent from heaven arrived with her first aid kit containing painkillers and made the next few hours of my life bearable.

After the initial shock is over and immediate emergencies are dealt with, you need to figure out where you are going to go and how you will get there. This is when you will wish you knew something about the area and local hospitals. Personally, I went through a four-hour wait at the base of the climb, a wobbly carry down an extremely steep trail, and a 20-minute boat ride to get to the nearest road. There, with no idea how to find an ambulance, I was loaded into the back of an open pick-up truck and we flew down the bumpy streets at top speed while my climbing partner held onto me and the truck for fear of my flying out the back because the tailgate wouldn't close. Needless to say, these evacuations were tremendously difficult, both emotionally and physically, and could have been partly avoided had we known how to invoke the emergency rescue services. Indeed, a couple of days later when we had time to schedule it, I was taken in a clean ambulance full of medical equipment and four nurses from the first hospital in Krabi to another in Phuket. Unfortunately I hadn't done any research on the local hospitals so did not know the rumor about Krabi hospital being the worst. We arrived there at midnight.

I was roughly pulled out of the pick-up truck and dumped onto a stretcher. They wheeled me down the hallways of a dirty, partly open-air hospital, passing patients lying on metal benches pushed against the walls of the narrow corridors with IV-drips hanging above their heads. On the way into the emergency room I saw a doctor smoking in the hallway. Though I was in complete agony, my climbing partner checked out where the needles had come from and wrote down the names of the drugs before I received any injections.

The importance of our knowledge of first aid did not diminish once we arrived at the hospital. The most important thing about a back injury is not to allow the spine to move at all or else the cord can be cut and the patient is left paralyzed. Throughout the evacuation this is what we had focused on (hence the backboard) and were thoroughly relieved to arrive at the hospital with me still able to wiggle my toes and fingers. In our meager Thai we told them that I had fallen 20 feet and my back hurt a lot - obvious signs of a potential spinal injury. However, they wheeled me to the x-ray table and told me to get out of my stretcher and lie down on it. Absolutely stunned, we simply refused and persuaded them to get six nurses to lift me from the backboard to the x-ray table. (Several days later in a better hospital I had a CAT scan and was told that a broken piece of vertebra was protruding into the spinal canal and it was extremely important I not move at all until they performed an operation to stabilize the situation. Without a doubt, they confirmed, had I listened to the first hospital and stood up or been loosely carried, I would be paralyzed now).

Throughout that first evening, and over the next three days before we got to Bangkok, my feeble knowledge of Thai that I had acquired over the previous few weeks was absolutely invaluable. The first night we arrived at Krabi there was no one who spoke English and being able to say simple things like "I hurt a lot, please go slowly" to the pick-up truck driver, or "I fell six meters and my back hurts" to the nurses, or "we're staying down here" to the Thai men who wanted to carry me upstairs, made the whole experience a lot easier. The head doctor arrived on the scene and could speak reasonable English, but still the nurses who moved me, fed me, x-rayed me and gave me drugs could not speak it and the head doctor was obviously not around all the time to be our translator.

I met dozens of fellow travelers that were traveling without any insurance because of the relatively high cost of it. But I was glad I had it when, after one night in the first, very bad hospital, my insurance company arranged for me to be transferred to better facilities in Phuket. I thought of the two people on a beach who were collecting money to buy themselves food. They had been in their straw bungalow a few nights earlier and awoke in the middle of the night surrounded by flames and smoke. They ran outside in their underwear, sustaining only minor burns, and watched in dismay as the hut burned to the ground, along with absolutely everything they owned in that continent! Being foreigners unable to speak Thai and knowing no locals, they ended up being blamed completely for the lost bungalow and were charged about $3,000 for a simple, small straw bungalow with two wooden bed frames inside. They had no insurance and had to end their trip early to return home. Another traveler had been driving a rented car in South Africa and accidentally flipped it several times when he lost control. Being checked out at the hospital and paying for the automobile damage wiped out his account, though he luckily only suffered bruises. The anecdotal stories could go on and on. The point is that it happens, to regular travelers like you and me, doing everything from rock climbing to sleeping. The great majority of people I met never used their insurance of course, but you never know when you might lose an expensive piece of gear, or twist your ankle and need medical help, or have to cancel your trip due to problems at home and lose all your airfare. Travel insurance should be counted as an automatic part of the cost of any travel abroad.

Through my own experience at that very sketchy hospital, and hearing about many others since then, I must stress the importance of simply trusting your own instincts rather than blindly trusting the doctors. Think logically and independently about what you reason needs to happen, no matter how limited your medical experience may be. For example, everyone knows you must use sterile needles to avoid spreading disease, and you would normally just assume the hospital would be careful about that. However, it can't hurt to insist on seeing for yourself that needles come from a sterile package, and noting all drugs you are given and the time they are administered.

Similarly, of course if a doctor asks whether you are allergic to a drug before giving you it, you will tell him so. But it is a lot harder to be calm enough and think clearly enough in an emergency situation to remember to tell a foreign lady with a needle that you are allergic to something or other. (I was never asked if I was taking medication or allergic to anything until I got to the large hospital in Bangkok). Likewise if you are diabetic, pregnant, or have any other medical condition, remember to proactively offer this information to every doctor you interact with, even if they forget to ask.

I was told at the first hospital that I had broken my Lumbar vertebrae, and by the second hospital that it was the Thoracic12 vertebra. The third hospital did yet more x-rays to make sure they got it right before the operation! If it is possible, also try to contact doctors from your home country since medical procedures can differ from country to country. Your insurance company and your embassy are good places to contact for advice on where to go and which doctor to consult in a foreign country in an emergency. Also they might help with talking to a medical expert back home to ensure you have the right operation performed.

I don't mean to make you paranoid safety freaks, but just want to give you a quiet reminder about the value of being prepared for a disaster. You may not be a rock climber or skier or engage in any dangerous sport, but statistics from the U.S. State Department say that the most frequent cause of injury among travelers is just that: traveling. Buses, trains, rental cars, motorbikes - these are the cause of the great majority of serious injury abroad. When I was in Phuket hospital (the second of the four I was in) the doctors told me they were experts at dealing with spinal cord injuries due to the huge number of motorcycle accident victims they see every day. (In fact that very night I was there, three Western backpackers were brought in with serious injuries due to motorcycle accidents).

These days everyone goes backpacking alone through third world countries. It seems that finding a hostel, Internet cafe, or someone who speaks English in Bangkok, for example, is easier than doing so in Paris! This makes life easy for travelers upon arrival, but may lead to a false impression of modern conveniences and safety net that are not actually present. It is extremely important to be aware of your surroundings and prepare yourself appropriately for the countries you will be visiting. Every country is different, and constantly changing, so it would be impossible for me to outline medical procedures all over the world, and unrealistic for you to research them all if you are traveling to many places without itinerary. So most important take-away is: be independently capable of dealing with emergencies. Don't count on being saved by a magic western helicopter to take you to a clean white hospital from ER. Be an independent unit - your brain, your nerves, your first aid kit, and your traveling companions.

And finally, remember that among the hundreds of thousands of people who travel every year, very few actually encounter any problems. Medical emergencies are extremely rare, evidenced by the profit margins of travel insurance companies. Don't get put off by my one horror story - I survived a major accident, injury and operation in a developing nation and three months later I backpacked around Europe. Enjoy yourself and have safe adventures!

* Don't forget to check out the special travel insurance section