Sick of paradise ?! Dealing with ill health abroad.

I think the 5 months of almost constant travelling, scoffing of unusual street foods and swimming in the the ocean finally caught up with us. Here in Bali, we have all been ill. Their experiences have given us different insights into the way healthcare works here in Bali – for we have spent quite a lot of the last few weeks visiting different hospitals!

Visiting a hospital is a strange phenomenon for us. In the UK we have the excellent NHS-funded GP, who is usually the first port of call for any non-emergency health problems. We don’t see too much of our GP back home as luckily, we’re a pretty healthy bunch. Secondly, I work in a department which is in the same building as the wonderful Walk-In Centre team of nurses in Exeter, who run a nurse-led minor injury unit. They are brilliant at managing most every day bumps, scrapes and other minor health problems; and are excellent at helping out with any, ‘What would you do about this…?’ healthcare-type scenarios. It was these kind folks who helped us put our first aid kit together!

So for non-emergency health care worries, we are generally sorted. Plus, being a nurse myself, we only go to hospital if its a REAL emergency.Hospital

However, we are discovering that for many people in the world, a hospital is their first port of call for any medical problems. The other big difference is that unlike in the UK, where healthcare is free at the point of care and paid for via taxes, most people have to pay upfront for any medical care they receive. Depending on the type of hospital and its location, prices vary massively. We have full, comprehensive travel insurance with Alpha Travel, covering every and any medical emergency. However, this only kicks in after the first £100 spent for each individual problem. You can probably guess that we have spent a lot of money on healthcare in the last few weeks. I feel so fortunate that we have the NHS back home.

BIMC Hospital, Kuta

Rosie had a stomach upset on and off for about a month. It started just before we left Kuala Lumpur. She complained of abdominal pain and had diarrhoea most days during this time. However, she never seemed ‘ill’ and didn’t get a temperature or vomit, and otherwise seemed OK. I assumed it was probably ‘travellers diarrhoea’, which is common in Asia. But it didn’t seem to settle, so after a month, I started to consider the other causes – namely the possibility of a parasitic infection. It’s all fun and games joking about having a ‘worm’ in your stomach making you feel hungry ((guilty))- until you worry that you actually may have one…

So off we went to hospital.

On this first occasion, we went to the BIMC Hospital, based in Kuta. It is Australian owned and the biggest International Hospital in Bali. It took us about 40 minutes to get there on the motorbike as it was over 20km away from where we are staying. As we were travelling along with a glass jar containing a fresh ‘sample’ from Rosie in my handbag, I was a bit worried about what would happen if we encountered any big bumps in the road. At this point, I figured that an accident would have been really quite unpleasant!

After arriving at the hospital and checking in at reception, we were seen quickly by a doctor. Rosie had a full examination and had her temperature taken. The doctor took her medical history and asked lots of questions about our recent travel history and about foods we have eaten (street food?).

She advised that Rosie’s history didn’t seem typical of a parasitic infection, although she would prefer to send a stool sample, just to make sure. Normally 3 samples are sent, but she explained she would feel reassured if one sample returned with a negative result. She suggested that she would prefer not to treat with antibiotics speculatively; she felt Rosie was most likely suffering from travellers diarrhoea, that she was probably a bit sensitive to Bali bellybacteria in the local food and things would probably settle in time, especially if she stuck to her normal back home diet of ‘Western food’. Rosie was very pleased to hear this! In addition, the doctor recommended drinking daily Yakult probiotic yoghurt drinks, which she suggested may help.

We paid the 680,000 IR (£36) and jumped back on the bike, complete with a new sample pot. Apparently any sample over an hour old isn’t very reliable when looking for parasitic infections. We’d have to try and catch another one and drop it to the lab in a few days…

As luck would have it, and as anyone with kids will know, over the following few days as I hovered anxiously every time Rosie announced she needed the loo, and after 5 weeks of daily bad tummies, a hospital visit, a long bike ride and £36 later, miraculously, Rosie was 100%, completely better!  The good thing about this, besides the obvious, is that I haven’t had to catch the worst kind of ‘sample’ using a plastic bag or jam jar. Clouds and silver linings and all that.

Unfortunately, I think all the tummy business meant that Rosie was a little run down. Within a few days of feeling back to normal, the poor little thing was in real pain with ear ache. Everything I read online said there isn’t much that can be done to effectively treat ear infections, unless the pain dramatically worsens or fails to settle after about 72 hours. So we bought most of the available calpol and ibuprofen in Bali, and waited it out. On day 3, just as I was losing faith, Rosie awoke to find her ear drum had perforated during the night, releasing the infection and she announced was feeling better! Hooray!

We spent the next week ensuring her affected ear had no contact with water to try and ensure it wouldn’t get reinfected. Not easy when staying in Bali and everything is centred around beaches and swimming! We just about managed it.

Unfortunately for Rosie however, the following week, her other ear became infected. This time however, it appeared a lot worse, and no amount of calpol or ibuprofen would settle the pain. After a very unsettled night and an even worse daytime, I decided she needed to get it checked.

Dharma Yadnya Hospital, Denpasar, Bali

Our accommodation here in Denpasar is actually right next to a local Balinese hospital. Yok, our host at the homestay where we’re staying, suggested that Rosie could be seen by a good ENT consultant there at the hospital. He kindly agreed to accompany us to try and facilitate an urgent appointment and to translate if necessary. Within 15 minutes, we were checked in and saw a kind older Doctor, who spoke excellent English. He examined Rosie by using an otoscope, which projected the image of her inner ears onto a TV screen. Had Rosie not been in so much discomfort, I think she would have been really interested!

He diagnosed an outer ear infection and said he wanted to clean the ear, before prescribing some ear drops and better pain relief and oral antibiotics. As he prepared his equipment for the ear-cleaning procedure, I’m glad Rosie didn’t see, as I was feeling a little nervous about it myself. He warmed a long thin metal instrument under a bunsen burner. Yes, just like those ones we had at school. Then, he wrapped the end in cotton wool, before dipping it into some kind of very strong antiseptic. This instrument was then poked into poor Rosie’s bad ear. I’m not quite sure if this was NICE approved, evidence-based medicine; all I can say is that it was extremely painful for poor little Rosie, and awful for me to watch. However, once it was over and within a few minutes of leaving the department, it did seem to have worked some kind of magic. She was either in severe shock, or it had done the trick to settle some of the pain?!

We paid the doctor his 300,000 IR (£16) and left with a prescription for medicine, which was made up especially for us in the pharmacy for another 275,000 IR (£14.50). The doctor said she wouldn’t like the medicine and we should try mixing it with ‘something sweet’. The pharmacist laughed on looking at her script and said she wouldn’t like it either. She suggested we should add sugar when giving it. Once we’d been given the powder sachets, which we were supposed to administer twice a day for 7 days, I read the components: Clindamycin antibiotic, ibuprofen, diazepam (!) and Vitamin B. The powders smelt foul. Once at home, we mixed one with about 15mls of strawberry Fanta – the sweetest, most highly coloured, artificial drink known to man. I didn’t tell Rosie that I’d added the medicine and hoped she wouldn’t notice. She took 1 sip and almost threw up. And that was the end of that! There was no way we could ever get her to take any more, however we might try to disguise it! She did however manage brilliantly with the ear drops, and after 4 days, finally, she was feeling better. At last!Feeling well!

Aaron had an episode of high fever and a dodgy stomach whilst we were staying in Penang, Malaysia. He was so unwell  that he actually passed out in front of me in the bathroom, which was a bit scary. I’m used to people passing out at the clinic where I work, but this is usually after I’ve done something horrible to them, so it can be kind of expected. You get used to looking for the signs. With Aaron though,  I initially thought he was actually joking around: he fell to the floor in a kind of slow-motion, comedy kind of way. After abut 10 seconds when he didn’t move or get up,  I realised he wasn’t kidding and quickly flew into nursey action. The poor guy. When he came to, he didn’t remember anything and wondered why he was lying on the bathroom floor?

We just assumed it was all caused by a viral infection, and after a few days in bed and lots of paracetamol, it appeared to pass.

The symptoms recurred again though in the first few weeks of our stay in Bali. This time it seemed to be more of a cold / flu virus, but again accompanied by a very high temperature and shaking. This time it lasted for about a week before he picked himself up again.

Amongst all the the recent Rosie dramas, Aarons symptoms recurred AGAIN. This time, combined with several weeks of sleep deprivation due to keeping a nightly bedside vigil for Rosie and her bad ears, I panicked a little. After an awful lot of worrying and checking up on Dr. Google at 4am, I was convinced he MUST have something serious. After a third episode of unexplained symptoms, I felt it was time he got himself checked out. In fact, why hadn’t I acted sooner and made him seek medical attention before now? Eeek! Added to these concerns was the knowledge that our next destination in just  few weeks is Vietnam, where access to good healthcare isn’t so reliable. I didn’t want to take any more chances, especially if it WAS something serious.

First thing the next morning, Aaron went to hospital.

Bali Royal Hospital, Denpasar

Sick bayYok wasn’t available to help us attend the Dharma Yadnya Hospital this time and the BIMC seemed too far away to travel to as a family, especially as Rosie was still unwell with her ear infection. So Aaron headed off alone on the motorbike and visited the Bali Royal Hospital instead. Located in Denpasar, this is a fairly new, private International hospital.

What a great service- he was checked in to the emergency room within 2 minutes of entering the building! After being thoroughly examined and questioned about symptoms and his medical history, Aaron had blood taken for Dengue Fever, Typhoid, and had his blood counts checked. The doctor advised that malaria testing was not required as we haven’t yet visited any malaria-prone regions. Typhoid however is very common in Asia and despite being vaccinated for this as part of our pre-travel preparations, we have met several people who have been unlucky enough to contract it, despite vaccinating.

Lucky for him though, Aaron’s blood tests were negative to both Dengue and Typhoid. His inflammatory markers were slightly raised though, so he was reassured and packed off home with some antidiarrhoeals, with the advice to repeat the blood test again in 48 hours. This second blood test came back normal. (Man Flu).

The bill for his care came to almost 1,500,000 IR (£80) and we’re hoping this was enough to frighten away any the mystery illness once and for all!

Dr. Alex

A strange mark came up on my leg soon after arriving in Bali. It wasn’t like any of the other bites or rashes we’d experienced so far on the trip. I tried applying hydrocortisone cream onto it for a few days, but that just seemed to make it worse.

Aaron then piped up and said it looked a bit like I’d been bitten by a spider! Hmmm. I don’t like spiders at the best of times and I’ll be damned if one was going to finish me off on my year off! Then I really started thinking: what if this was caused by one of those Bot Fly larvae I’d seen a few years ago on YouTube (DO NOT CLICK ON LINK IF YOU ARE NOT OF A STRONG COMPOSITION)?! Was a maggoty worm thing going to make a surprise entrance from the rash on my leg? Aaron had got me worried now. Alone in a strange country, what else was there to do? I decided to consult with my good friend Dr. Google. I was sure I’d be able to accurately diagnose myself using this reliable platform of information. And in fact, on searching images for ‘spider bites’, in amongst the photos of people’s limbs rotting and dropping off, I found an image showing exactly the same rash that I had! Oh dear. So what should I do now? Surely I only had a few hours left to live. Who do I know who is experienced and qualified in Tropical Medicine and UA Medicine (Unusual Afflictions), and who could advise me how to apply a decent tourniquet and help save my life? None other than our great friend, Dr. Alex!

After a Facebook messenger consultation and photo exchange from Bali to Cyprus, I had my diagnosis: not a spider bite, but Ringworm (a fungal skin infection).  He explained that a simple course of anti fungal cream would surely clear it in a week or so. I think he typed that advice without chuckling to himself too much. I was, of course, extremely glad to know I wouldn’t be dying any time soon and relieved that our trip could continue without further drama or medical bills.

However, I couldn’t shake the thought that on this trip, I just knew, that somewhere, in someone, a worm would be involved.

Just why did it have to happen to me????!

Medical records
Medical bills

 

 

2 thoughts on “Sick of paradise ?! Dealing with ill health abroad.”

  1. I often find myself jealously day-dreaming about your romantic trip. Thanks for bringing it all back down to earth!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s