NPR logo If You Fall Ill Abroad, Should You Seek Local Help Or Head Home?

If You Fall Ill Abroad, Should You Seek Local Help Or Head Home?

If you fall seriously ill in Poland you can count on good care at a private hospital but should probably steer clear of the public ones.

In Botswana, an otherwise survivable road accident could prove deadly owing to lack of good care. But in some areas of neighboring Namibia there's a decent chance emergency medical personnel can stabilize you.

And if you have a heart attack, your ticker should be in good hands in Sao Paulo.

Those are some of the therapeutic lessons you can learn from International SOS's annual ratings of medical and dental care abroad. The company offers emergency medical assistance to companies whose employees work and travel abroad, including media organizations like NPR.

It's a complicated world out there, that's for sure. Consider Brazil. "Their private health care infrastructure is as competitive as anything you would find in the United States," says Dr. Robert Quigley, senior vice president of medical assistance and regional director for International SOS.

But he warns that if the chest pains start while you're in some other part of Brazil — for instance, the northern city of Manaus — the staff at International SOS would most likely advise evacuation as soon as possible.

"Let's suppose you need cardiac catheterization — where they inject dye into your arteries to see if you're having a heart attack and then, if you are, they do an intervention like deploying a stent," he explains. In Manaus you might get seen by a cardiologist who can do all that, but the hospital won't have the ideal level of equipment or staff training. "If you're managing someone with an evolving heart attack, it's not just a question of having a cardiologist. You need an intensive care unit, nurses available 24 hours a day, all those things we take for granted in the United States."

Brazil is perhaps the starkest example of a special category: countries where the variation between health care in urban and rural areas is so extreme it's impossible to come up with a single "risk" rating for the nation as a whole.

Also in this mixed-bag category is China. While care remains basic in the remote countryside, "every time I go to China I'll visit a hospital in a major city where the brick and mortar" — the physical structure of the hospital and the equipment inside — "is phenomenal."

Still he adds, even the fanciest Chinese hospital doesn't measure up to the best in Sao Paulo. In China, he says, "they've got CAT scans and MRIs, and it all seems brilliant. But then there's not the proper training on how to use the machines."

To China's credit, he adds, the country seems to be pouring resources into closing the gap. Quigley says recent investment dollars have also made a big difference in two African countries: Kenya and Namibia. He notes that the combination of natural resources and cheap labor in those countries has attracted a lot of international companies from the energy, mining and infrastructure sectors. These, in turn, have brought over a sizable expatriate workforce.

"Whether it's in the spirit of feeling a duty of care toward their expatriate employees or a sense of corporate responsibility [to the host country]," Quigley says, "a lot of times these companies will say, we should be investing or partnering with someone to improve whatever the existing health care services there might be. And in the last couple years we've seen a lot of private enterprises, including some of the recognized brands, investing dollars in brick-and-mortar facilities."

Quigley doesn't want to overstate the quality of care at these new places. "I would call them centers of adequacy," he says. For instance, if somebody is in a road accident the facility may be able to stabilize the person and even perform some basic procedures. "But the patient might need neurosurgery and that might not be something we'd want done in those centers of adequacy."

Also, the higher caliber of such facilities is of little consequence to the majority of Kenyan and Namibian citizens who can't afford them. Still, the standards achieved there are impressive in a region where almost every other country has been shaded orange for "high risk," or red for "extreme risk."

That latter designation is generally applied to countries experiencing violent conflict. Syria, Libya and Iraq are all colored red, for example. Then there's Venezuela, where, Quigley says, the problem is mainly economic instability.

"That makes for a reimbursement system that is such that you often can't even pay [medical] practitioners. So nobody wants to work there, and you end up with poor-quality clinicians, and that's reflected in the care they give."

Countries where there's a robust supply of top-notch medical staff are obviously a better bet for travelers. But even those nations can be risky if too many of the best practitioners are concentrated in private hospitals rather than public ones.

"Remember," warns Quigley, "the EMS equivalent in these countries tends to be affiliated with the public hospital system. So if you're hit by a car, you're going to automatically get taken to a public hospital, where you run into a whole lot of issues around their comprehension of hygiene — how they process blood to ensure it's not contaminated, for example."

This scenario is an issue not just in nations such as Thailand, Mexico and India but in Eastern European members of the European Union such as Poland, the Czech Republic and Croatia.

Of course, when it comes to elective surgery, private facilities at some of these countries can often offer excellent service at a fraction of the price charged by U.S. hospitals. So what about heading to Brazil for that nose job you've always wanted? Or fertility treatments in Thailand?

Quigley shudders at the notion of "medical tourism": "The 'MT' word is considered sacrilege in the arenas in which I work."

The trouble, he says, is that "people will go to places like Brazil or India and get what may be a good surgery for half the price. Then they come back and have a complication and nobody in the United States will want to care for them. We are such a litigious society that the provider will say, 'I don't want to take on someone else's mistakes. If you've gotten a bad nose job and I can't fix it, then my hands are dirty.' "

So while International SOS's staff gets plenty of calls from people seeking advice on the best places to go for optional procedures abroad — dentistry, plastic surgery and the like — that's the one medical question it refuses to weigh in on.