Ummm, I feel… sick.

August 8, 2009 2:53 AM

Suit cases packed, check. Did I turn off the stove, check. Electricity bills paid, check. Now all I have to do is catch my Plane at the Airport, and I’m off. One full month of rest and relaxation. What could be better, right. Wrong. Here are some of the best countries to get sick in.
posted by hadjiboy (30 comments total)

I am not sure that "best country to get drugs OTC" is quite the same as "best country to get sick in".
posted by cmonkey at 4:00 AM on August 8, 2009 [1 favorite]

While technology and cleanliness-wise, Morocco may not be at the top of that list, I just want to send a personal shoutout to the staff of the hospital in Marrakesh which nursed me back to health after I collapsed in a bus station and wound up in their care for two days. I was showered with attention in the gastrointestinal ward and treated with a lot of compassion as we struggled to communicate with my awful French. Total cost for my care, two-night stay, and medicine? $80. Aside from a mildly-thrombosed vein from a slightly less-than-perfect IV drip, I totally recovered within a few days. Compared to the $100 I had to pay at the low-income/sliding-scale clinic back in California (which was otherwise good; not sure how someone who makes less than five digits annually has to pay three, though...) when I was jobless last summer for a doctor to check out an ear infection acquired while swimming in dirty seawater and give me some free samples of medicine, it was a steal.

Living in Poland now, things are not as cheap and a bit more bureaucratic, but I'm lucky enough to not have become ill so far. My fellow non-Polish friends and colleagues have had babies, had root canals done, and gone for specialized care for specific chronic diseases, and all have no complaints.
posted by mdonley at 4:17 AM on August 8, 2009 [3 favorites]

Something not mentioned by the prescription drugs article was that ... in non-first world countries the incidence of counterfeit prescription drugs is significant.

The fact that you can buy something doesn't mean it will be what the label indicates ... at best you end up with the product purchased, possibly with something merely harmless, alternatively with something that could be lethal.

Do you buy prescription drugs over the internet? Same deal!

Is it worth the risk? that is up to you to decide.
posted by jannw at 4:30 AM on August 8, 2009

That second link ('best countries') seems dodgy at best; it seems to be based on the notion that the only consideration when a person gets sick is the cost of drugs. He even says “thank goodness” he got malaria in Tanzania, since the over-the-counter drugs were so cheap and readily available.

It certainly would've been a real hassle if he'd gotten malaria in the Germany or the UK, considering how much trouble he would have had to go through to get the proper medicine. Not to mention how much of a horrible mess he would've had to wade through if he'd gotten malaria in the USA—say, if he'd contracted it in a place where the infrastructure is really bad or the pharmaceutical laws are very stringent like Illinois or California. I'd say he really dodged a bullet, just happening to be in Tanzania like that when he got bit by the Tsetse fly.

Of course, one hopes that he brought along his Merck Manual so that he can figure out which drugs he's actually supposed to buy, given that Tanzania seems to be located in the very center of the absolute lowest concentration of doctors per capita in the entire world; Sweden, say, has 33 doctors per 10,000 people, Switzerland has 40; Tanzania has less than one.

Since it's easy [n.b.: it's not] to treat a case of malaria yourself with pills you buy from a dodgy pharmacy, I'm sure this wouldn't be a problem.

The first link is somewhat interesting, although I wonder if the problem in China is “specialization” as the author puts it; it seems as though the problem is a lack of regulation, whereas it may very well be that in the US the problem is over-specialization, but my sense is that, in the same way, regulation in the US is rather misapplied and badly-devised.

It seems as though, when choosing countries to get sick in, you might be best off just consulting the 2009 WHO figures on Health workforce, infrastructure, essential medicines which were recently released, maybe tossing their 2009 figures on Health inequities and Demographic and socioeconomic statistics into the bargain, too.

In fact, the premier source of information on health and sickness in different countries is almost certainly the World Health Organization's World Health Statistics 2009 [ Around 150-page PDF: Arabic (9.35Mb) | Chinese (6.85Mb) | English (6.05Mb) | French (6.70Mb) | Russian (4.85Mb) | Spanish (3.91Mb) ] of which the above are only three sections.
posted by koeselitz at 4:49 AM on August 8, 2009 [6 favorites]

It's handy that they have the WHO Statistics in all those languages. If you happen to get sick in a country like Tanzania, you'll probably be able to find someone who at least knows Arabic, point out to them the statistic about there being almost no doctors in his country, and share a sad, frustrated silence between you which will probably be the most therapeutic treatment you can hope for.
posted by koeselitz at 4:57 AM on August 8, 2009 [4 favorites]

jannw: Something not mentioned by the prescription drugs article was that ... in non-first world countries the incidence of counterfeit prescription drugs is significant…The fact that you can buy something doesn't mean it will be what the label indicates ... at best you end up with the product purchased, possibly with something merely harmless, alternatively with something that could be lethal…Do you buy prescription drugs over the internet? Same deal! Is it worth the risk? that is up to you to decide.

I think I must be misreading what you're saying here. Are you sincerely saying that drugs bought over the internet in first-world countries can be just as harmful as drugs bought in person in third-world countries? I see you're in the Netherlands, so I guess what I'm partially asking is: can you really get such drugs over the internet in the Netherlands? Here in the US, internet-sold drugs are often more regulated than drugs sold in person; and at the very least they have to meet the same requirements. I find it a little amazing that you can get such stuff over the internet there, but I guess it makes at least a little sense; you can probably get those things here, too, it just hadn't occurred to me.
posted by koeselitz at 5:01 AM on August 8, 2009

@koeselitz "Are you sincerely saying that drugs bought over the internet in first-world countries can be just as harmful as drugs bought in person in third-world countries?"

Yes, I am, and I work in counterfeit detection and prevention.

1st world pharmacies effectively provide a bona fide distribution chain. Internet purchases do not. Has your internet drug vendor purchased authentic product? How can you be sure? Where are they based? Are you sure? Who regulates them? Are you sure? Can you with 100% certainty validate the bona fides of an internet vendor? In most cases the answer is NO!

Anyone, anywhere, can set up a online shop and sell anything they want ... thus internet purchases are always a case of "caveat emptor" ... which is fine for a book ... but not worth the risk for prescription drugs.

I am not saying all internet drug vendors are illegitimate ... but can you 100% verify the one you choose to purchase from, and their supply chain? Really? Are you sure? Is it worth the risk?
posted by jannw at 5:20 AM on August 8, 2009 [6 favorites]

I got sick during my honeymoon when I was out of the country. Apparently "Imodium" is a magic word. Everybody knows what you're talking about.
posted by taumeson at 5:44 AM on August 8, 2009 [1 favorite]

This post needs a link to IAMAT, the International Association of Medical Assistance to Travellers. Membership (which is free) gives you a huge list of doctors internationally who speak English, and preferred rates at their clinics. They also sell kick-ass mosquito nets at cost, and have good info on their site about travel health.
posted by carmen at 6:28 AM on August 8, 2009 [2 favorites]

jannw: Yes, I am, and I work in counterfeit detection and prevention.

Hmm. That's really interesting.

I've never heard of this happening here in the States—I wonder if that's because it doesn't really happen here at all, or if it's rather because I'm just not 'in the know.'
posted by koeselitz at 6:43 AM on August 8, 2009

I suspect that I just haven't heard of it—looks like there are a lot of these rogue pharmacies out there…
posted by koeselitz at 6:47 AM on August 8, 2009

Yep.
posted by koeselitz at 6:50 AM on August 8, 2009

Tis doesn't speak so much to the pharmaceutical debate some of you seem to want to have, but here's a story. A friend had his appendix out while on vacation in the Philippines recently. His wife wrote up a lengthy piece for another message board, which I think is okay to excerpt and redact here:

...Next day we flew back to Manila, and [he] was feeling really bad by then. His pain was a lot worse. We arrived at the hospital, checked into the ER, and after several hours of tests and prodding and pokes, plus a CT scan they determined that he had a probable ruptured appendix. That evening, he underwent an emergency appendectomy in Manila. Meanwhile I waited in the surgery waiting area under the massive painting of Jesus and the words "In Jesus we Trust". Good thing I trusted the surgeon too.

Surgery went well, and the doctors were wonderful. They were able to remove the appendix laparascopically, which means 3 small incisions (one for each of the surgeon's hands plus one for the camera that's inserted) that heal quickly, rather than one large incision that heals slowly. They repaired a hernia along the way also. [He] was very relieved to have the thing removed along with the pain.

I got a good look at the extracted appendix in a little cup; the doctor had learned I was a biomedical researcher and wanted to show me as soon as he had scrubbed out of the surgery. "Do you have your cell phone camera? Take a picture!" Then, picking out an object with a pair of tweezers, "Look here's a fecolith!"

[He] spent another 4 days in the hospital with a drain hanging out of his stomach (a.k.a. "the grenade" for its appearance). Fortunately the bladder catheter was removed on first day (ouch!). The nursing care was superb; and he got more personal care from the doctors there than he ever would have back home. The surgeons visited every day; one of them, who had gone to med school in Vermont, came just to chat also. The surgeon admonished [him] to not do it the American way, but to "recover the Filipino way": take your time in the hospital till you're really well enough to go home. He gave us his personal cell phone number and email. Whoa.

Grand total for surgery, 5 days in the hospital, emergency room fees, surgeons' fees, CT scan: about $6000. (Now I understand medical tourism.) I just put it on the credit card.

They came away basically paying less for the entire procedure than what would have been their deductible/copay in the US, and got more personal care & more time to recuperate, in a third-world country.
posted by Devils Rancher at 6:51 AM on August 8, 2009 [1 favorite]

I was pretty amazed not to be able to purchase antibiotic ear/eye drops in stores in the US not long ago. Had to make do with mouthwash for that minty-fresh ear effect!
posted by fish tick at 7:16 AM on August 8, 2009

They came away basically paying less for the entire procedure than what would have been their deductible/copay in the US [about $6000]

Of course if they'd been in a lot of other countries, the UK or Italy for instance, they would have likely* had it performed completely free.

*Obviously if they were residents it's definitely free. As visitors they're technically supposed to pay (or have travel insurance that will) but I've never seen that happen yet.
posted by NailsTheCat at 7:56 AM on August 8, 2009 [1 favorite]

Devil's Rancher, I don't think that's necessarily that unusual. The difference is that in a third-world country, $6,000 may be a bigger number than a lot of the local population can afford to pay. This is purely anecdotal, but I got very sick in the Republic of Georgia; I was cared for at home by my host family and got excellent follow-up care from them and from specialists (who made house calls, called me by my first name, joked about marrying me off to their children, etc.). However, my host mother was a cardiologist and one of her chief complaints was that many, if not most, of her patients could not afford any sort of medication, even if they had serious heart conditions. I got very, very good care, probably very cheaply, but it became very clear to me during my time there that most of the locals would have struggled to pay some of the costs associated with my condition.
posted by posadnitsa at 8:07 AM on August 8, 2009 [1 favorite]

I gather some countries are pretty damn good for plastic surgery. I've given some serious thought to doing my next one elsewhere, but the research is tough. Aside from having to cut through the usual "if it's not American, it's not the best," you have to wonder just how much fear, uncertainty, and distrust is bought and paid for by the AMA, given that they would naturally have an interest in making United States citizens terrified to have medical procedures elsewhere.

Sometimes, anecdata is about the only semi-clean data you can get.
posted by adipocere at 8:36 AM on August 8, 2009 [2 favorites]

I vote Monaco.
posted by rageagainsttherobots at 8:45 AM on August 8, 2009 [1 favorite]

The difference is that in a third-world country, $6,000 may be a bigger number than a lot of the local population can afford to pay.

I'm sure there's a cost/income gap correlation across the board. If you make $3.00 a day, there is no state-run health program, (ie free is not an option) and you have no insurance, then yeah, it might as well be a million dollars for the procedure. I wonder what the difference between the cost/income gap is in different countries. If you make $50.00 a day in the US, (figure full employment near minimum wage) and have no health insurance, the ~$100,000 an appendectomy & 5-day hospital stay is similarly out of reach.

The question is then is the gap that wide everywhere? It sounds like it's not.

Here's another piece of anecdata: I had a kidney stone 2 years ago. I spent all of 1.5 hrs. in the emergency room, got 1 cat scan, 1 shot of morphine (jesus fuck the pain. I mean seriously, jesus! Fuck!) and sent home to pass the thing, as it was too small for any removal or ultrasonic crushing procedure. Hospital bill, not including physician's group, anesthesiologist, or lab (cat scan) was $10,000.00. Grand total with all the other bills was close to $15,000.00. This all happened 2 weeks after I had completed a bankruptcy, so filing another one would not have been an option. My insurance was pretty fucking slow to pay too & I lost hours of work & time at home making phone calls & shuffling paper. It was pretty unpleasant all the way around.
posted by Devils Rancher at 9:00 AM on August 8, 2009

Here are some of the best countries in which to get sick.
posted by pearlybob at 9:14 AM on August 8, 2009

Here are some of the best countries in which to get sick.

Just so you know, there is no rule in English grammar that says you can not end a sentence with a preposition. That's a common misconception. It's merely a matter of style.
posted by ValkoSipuliSuola at 9:22 AM on August 8, 2009 [1 favorite]

Guess this is all from the US perspective but those with European passports travelling in the EU and Switzerland should definitely accompany them with a free European Health Insurance Card which will give you access to other countries' state-provided healthcare systems on the same terms as a local resident, or better.
posted by athenian at 9:46 AM on August 8, 2009 [1 favorite]

My favorite "sick in a foreign country" story is how in Iceland, I was quarantined for being an American.

There was a good reason for this, but I just really loved how people had to wash their hands with alcohol before touching me and I was kept in this special room, not because of my illness - which was non-contagious - but because I'm American. Good times.

The reason is that Iceland doesn't have any "native" staph bacteria, whereas Americans are exposed to some pretty bad-ass stuff on a daily basis and they had to swab me to be sure that I wasn't going to make everyone else in the ER develop a raging infection in their open wounds. Pretty dull as far as quarantine goes.
posted by grapefruitmoon at 10:53 AM on August 8, 2009

I got a fairly severe tummy bug right after returning from a work trip to India this year. A helpful colleague suggested champagne as the solution. "Because of the bubbles?" I asked.

"No, the cork's just the right shape," he said.
posted by MuffinMan at 10:58 AM on August 8, 2009 [1 favorite]

ValkoSipuliSuola: if anyone tells you not that it's ungrammatical to end a sentence with a preposition, the best soluition is to tell them to "sod off."
posted by MuffinMan at 11:04 AM on August 8, 2009

ValkoSipuliSuola: if anyone tells you not that it's ungrammatical to end a sentence with a preposition, the best soluition is to tell them to "sod off."

Winston Churchill's (alleged) response to a similar criticism is less concise but equally valid.
posted by NailsTheCat at 11:20 AM on August 8, 2009

Canadians know that you should never, ever set foot into the U.S. without some form of travellers' health insurance. It's kind of like how you would never set out to hunt Dracula without a cross, a stake, some Holy Water and a bit of garlic on hand.
posted by you just lost the game at 12:14 PM on August 8, 2009 [1 favorite]

Good health > not getting sick > taking all the drugs you want.
posted by l33tpolicywonk at 2:38 PM on August 8, 2009

A preposition is not the sort of word you end a sentence with.
posted by Devils Rancher at 3:27 PM on August 8, 2009

The difference is that in a third-world country, $6,000 may be a bigger number than a lot of the local population can afford to pay.

There's certainly a point to be made that people tend to be paid to a standard of living, not a magic number. A good surgeon is, in general, going to enjoy a very good income wherever he or she lives, relative to people with more easily attainable skills.
posted by rodgerd at 5:56 PM on August 8, 2009