The good news is my admirals assert that they are much healthier cruising than they were back home.  They attribute this to spending more time outdoors and less in crowded or enclosed spaces, to being more active and having a better control of what they eat, and of course to living more stress-free lifestyles.  However, just as things do go wrong with the boat, no matter how careful our maintenance, things can and will go wrong with our bodies as well.

Some cruisers are more regimented in their preventive care while others wait for problems to crop up.  Most of us have been taught to maintain regular checkups, gynecological exams and mammograms, as well as, more generally, dental and eye exams.  Because of living so much in the sun, most cruisers add dermatological exams to that list.  Cruisers who migrate regularly back to their home base often schedule their checkups with their regular doctors. This has the advantage, particularly as you get older, of having someone who has a baseline on your health against which to plot changes, and it is particularly desirable, if you have a physician you like and trust, if you can arrange to communicate with him/her by email when issues come up.

But overseas cruisers who do not fly home or who do not have such long-term trust relationships usually choose to get checkups and care from local doctors as they need it.  It is probably true that in many of the countries we visit, the infrastructure of fancy offices and new equipment may not measure up to what we are used to.  But it is also true that most cruisers find they get just as good care as they would at home at a fraction of the cost and can even get great deals on elective surgeries like LASIK, tooth implants or cosmetic surgeries!  And guess what?  Sometimes the facilities and equipment are more advanced than back home!

Kathy of Hale Kai gets all her check-ups and tests done in the Caribbean.  “It’s easy to find the name of a good doctor through the cruising grapevine. A doctor’s visit generally costs about $20, the doctors aren’t in a hurry like they are in the US, plus they don’t delegate away as much of the work. You can even order tests that you want directly from a lab without always having to go through a doctor, and they, too, usually cost less.”  I personally can second that finding for Central America, Mexico, Polynesia and Fiji. To make things easier and more complete for foreign physicians, many cruisers, particularly those with ongoing conditions, carry an onboard file of recent tests, exams, or x-rays.

Lower costs for medical care lead some cruisers not to bother carrying medical insurance.  These uninsureds are usually younger (invincible!) folk, individuals on tighter budgets, or those who have Medicare to fall back on.  Regarding invincibility, a young cruising family we know recently had to air-evac out their eight-year old daughter for suspected appendicitis. The evacuation, the surgery, and the week’s stay in the hospital ended up costing them about $4000 after the hospital cut its bill in half.  The father figured that would have been about the cost of medical insurance for his family of four for a year.  But what if the hospital hadn’t cut their fees, or what if something else happens?

A majority of my Admirals do carry medical insurance.  Some are lucky and have health care coverage through their husband’s military benefits or through their own retirement packages.  A few purchase non-US insurance, such as the popular plan in Mexico for about $250 or similar plans in Europe.  However, most of the rest carry private insurance with high-deductibles conceived to protect them against catastrophic accidents or illnesses while paying for routine medical expenses out of their own pockets.  Two international policies popular with cruisers from IMG (www.imglobal.com) and IHI (www.ihi.com) cover cruisers inside and outside the US, although the premise is that you remain outside the US much of the year.  Wherever your coverage is from, be sure you understand the ramifications of your policy. For example, a typical domestic policy might only cover you outside the US for 60 days, while one of the cruising policies won’t let you be in the US for longer than six months.

Mary of I Wanda points out a curious plus of private insurance. “During our cruise, Christian was diagnosed with cancer (and successfully treated). Had we still been working, this would have ended our cruising dream, because once you have a serious condition you become uninsurable in the US. We would have had to continue working until we were eligible for Medicare — 27 years later!”

Many cruisers augment their insurance with very affordable DAN insurance (www.diversalertnetwork.com). Even for cruisers who don’t scuba dive, membership in DAN includes DAN TravelAssist, giving you up to $100,000 of evacuation assistance coverage.  It was DAN that covered and coordinated Randy of Procyon’s air evacuation from the Galapagos to Quito that I wrote about in this column in the January 2008 issue.

Of course there are many times when we cruisers are out of reach of shore-based medical care and must take care of ourselves.  First-aid courses and kits are a must, and some cruisers augment these further with EMT or wilderness medicine training. Most physicians in or out of the country will write prescriptions for drugs like antibiotics and painkillers that cruisers could need in offshore emergencies or remote situations.  “We do self-treat far more readily than we would if we lived in the US,” says Mary of Camryka from Panama, “keeping a supply of antibiotics, antihistamines, painkillers, treatment for dysentery, etc. and relying on our Merck Manual and other books such as Where There is No Doctor.”  Additionally, the HF radio, particularly Ham radio nets, become indispensable for seeking emergency help from volunteer physicians on call, particularly on passage.

There are several areas worthy of special attention for cruisers wanting to keep healthy in the tropics.  Keeping hydrated is important; dehydration can bring on urinary tract infections, contribute to kidney stone formation, exacerbate the effects of diarrhea and muck up body chemistry when scuba diving.  Another is protecting yourself from insect bites (and diseases they transmit like malaria or dengue) with protective clothing, screens,  and spray with DEET as well as treating bites promptly with sting-sticks or hydrocortisone cream so you don’t scratch.  Cuts, sores, blisters, scrapes and scratched bug-bites MUST be treated with topical antibiotics, covered with band-aids, and kept out of sea water (although sterile saline – boiled water with added salt—is good) to control rampant infections.  This past season in the Pacific, we have personally known a half-dozen cruisers struggling with infections, including two that had to be med-evac’ed out, and one who nearly lost his foot!   As a doctor in Fiji told my husband, “Americans hate to cover sores, but in the tropics, a bandage is a must.”

So, in the end, overseas cruisers find that health care is far less a preoccupation than they worried it might be.  Most first aid kits are tapped for little more than band-aids and antibiotics, and medical help is available when you need it.  Indeed, by the time you have some years of experience under your belt, you may find yourself preferring the simpler medical systems overseas to America’s McMansion medicine.

Contributing Admirals:  Kathy Parsons, Hale Kai; Katherine Briggs, Sangaris; Mary Verlaque, I Wanda, Mary Heckrotte, Camryka; Jane Kilburn, Lionheart;  Laura Bond, Bolero; Rachel, Ventana; Susan Richter, Wooden Shoe; Debbie Leisure, Illusions; Cindi Blondin, Tashmoo;  Ellen Sanpere, Cayenne III; Janet Garnier, and others.

This article was published in the January 2009 issue of Latitudes and Attitudes.

Related articles (on this website)

• The Need to Know (Admiral’s Angle column #17)

Consider the story of Sheri Schneider of the Gozzard 44 Procyon. After many years of preparation and short-range trips to the Bahamas and Maine, Sheri and her husband Randy — in their 40s, fit and with Randy recently retired from the US Coast Guard — left Beaufort, NC bound for the Panama Canal by way of the Western Caribbean. They had a long-planned rendezvous with friends they’d made in the Bahamas to transit the canal and head for the Pacific. All went well on the transit, and they got an auspicious start on their first long passage – six days from Panama to the Galapagos – with near perfect sailing conditions.

On their first morning in Puerto Ayora, however, Randy woke with stomach pain. “We blamed it on the arrival lunch with our friends the day before and continued on with an island tour. But throughout the day and the following night, Randy’s conditioned worsened, and after some fruitless visits to the local clinic we realized the problem was becoming serious.” Thanks to their membership in DAN*, Sheri was able to make one call and the medical evacuation to Quito was arranged. Within a half hour of arriving in the emergency room, Randy was in surgery for a perforated ulcer!

Being sick in a foreign country where the language is different and the standard of care may not seem to measure up to what we’re used to is an anxious experience many cruisers encounter in their travels. Likewise, leaving the boat in an unfamiliar anchorage does not help. Yet both these experiences went well for Sheri and Randy because of two fundamental assets: membership in DAN, which coordinated every aspect of the emergency evacuation, and friendships with other cruisers they could rely on. Unfortunately, because the doctor in Quito recommended six weeks of recuperation, Sheri and Randy were forced to watch those friends sail on without them.

“When we finally departed for the Marquesas, we made great time, averaging over 160 miles a day the first nine days.” On May 8, however, with 1266 miles to go, a badly-timed lurch knocked Randy over and he fell onto the cockpit table hitting his back and his head. “At first we were most worried about a concussion, but the next morning Randy woke with major stomach pains again. “ Although the symptoms were somewhat different, by the 10^th, he could no longer manage his watches and was out flat below. He could not keep food, medication or water down, and he had not passed anything in days. Abruptly Sheri found herself single-handing a forty-four foot boat, standing all the watches, doing the navigation, handling the sails, even attending to the engine. They were halfway across the Pacific. “I was very much afraid Randy might die.”

From their first boat, a Macgregor 26’, Sheri and Randy worked at their sailing together. Obviously his Coast Guard career gave Randy a huge head start, but he insisted Sheri learn everything he did, and she was lucky that he was a good teacher, “a natural explainer.” They continued to learn together as they graduated over the next twelve years from the Macgregor in California and Oregon to a C&C 37 in Newport, RI, and finally in North Carolina to Procyon which they had built for them. Having the boat built meant they could have her fitted just the way they wanted, and four years later Sheri would have cause to appreciate the cutter-rig’s furling sails, controls led back to the cockpit, integrated cockpit navigation, and the single electric winch installed in consideration of Sheri’s bad shoulder.

But to Sheri on her own in the Pacific, the most important piece of equipment on Procyon was their SSB radio. Although their closest friends were long arrived in the Marquesas, Sheri could still be in touch with them via the morning crossing net. Alerted to her crisis, other boats on passage joined in to lend moral support by radio throughout the day, and three nearby Norwegian-flagged boats listening to the net changed course to maneuver into VHF range. Additionally Dr. Tom Walker of the catamaran Quantum Leap, although 500 miles ahead, daily talked Sheri through monitoring Randy’s vitals and administering treatments (enemas fashioned from a first aid kit syringe and some heat shrink tubing administered ten minutes every hour in an effort to ease the suspected blockage and combat dehydration.) “You can’t get that kind of support over a satellite phone.”

While Sheri juggled being both a full-time skipper and nurse, her friends, recognizing that Randy’s deteriorating condition required evacuation, took on contacting the authorities. Working with the USCG and French Navy, a nearby container ship enroute from Panama to Papeete was diverted to a rendezvous. Meanwhile, the Norwegian boats converged on Procyon and launched a dinghy to facilitate the transfer to the 700’ vessel.

This was Sheri’s worst moment. The ship could spare no crew to help with Procyon. Would Randy’s care aboard be any better than she was giving? Could Randy last the 2-3 days it would take the ship to reach Papeete? And should she go with him…which would mean abandoning the boat?

Suspecting he would refuse to go on that basis, Sheri decided to stay with their boat, but watching the ship steam away after Randy was hoisted aboard was an awful moment. “How would I find him? How would I get news? Had I made the right choice? As long as he was in the bunk below, I’d known I could count on him for a hug and to answer questions. Now I was on my own.” That night Jan and Eva on Necessity shadowed her and kept watch for both boats so Sheri could try for some much-needed sleep, but all the uncertainties continued to haunt her.

The morning brought good news. Unknown to them, the container ship had a French woman doctor as passenger who’d promptly put Randy on an IV. Hydrated and on a stable platform, his insides finally got a break, and the blockage, probably an intestinal adhesion from the surgery that had broken away in the fall, passed. Randy rebounded overnight and was able to tell her himself on the morning net.

Unfortunately, with 800 miles still remaining to Nuku Hiva, the wind was dying. Motoring now, Sheri had to deal with such practical issues as fuel supply and a clogging filter. Alerted to her concerns, their friends on Endangered  Species and Wind Pony in Nuku Hiva filled all spare fuel jugs and shuffled crew so that one boat could motor out to meet her with help. “I can’t tell you what it felt like when I saw Wind Pony motoring over the horizon, blasting Aretha Franklin’s “Respect” over their speakers.”

Now, fifteen months (and some thorough medical checkups later), Sheri and Randy sit on the lovely Procyon shifting gently on her mooring in Musket Cove as Sheri tells me this story. Around us are moored many of the players from this saga, friends for life. The Schneiders have sailed 5000 more miles since the Marquesas, including the vigorous roundtrip to New Zealand, with no further problems, and they have many more they mean to sail. “I didn’t want to go, you know,” says Randy. “It was a fait accompli by the time I knew about it. But I knew she would be okay. She had the abilities to do it.”

“And that’s the point of telling this story,” says Sheri, “that women need to know. They need to know about evacuation insurance, and they need to know about the importance of an SSB radio and how to use it to get help and support from nearby. But most of all they need to know their boat systems and how to sail the boat if the worst happens. Women came up to me afterward and called me a hero, but there’s not a thing heroic about it. It’s just being able to do what you have to.”

*DAN or Diver’s Alert Network is not just for scuba divers. Join at http://www.diversalertnetwork.org

This article was published in the December 2007 issue of Latitudes and Attitudes.

Related articles (on this website)

• Peace of Mind—Emergency Skills (Admiral’s Angle column #4)
• Taking Care of Ourselves (Admiral’s Angle column #30)