Photo: Chanintorn.v/Shutterstock

I Had a Medical Emergency Abroad. Here's What I Wish I'd Known.

Cambodia Wellness Travel Safety
by Zanny Steffgen Jan 20, 2024

It was September, and at that point, I’d spent most of the year living in Siem Reap, Cambodia, after falling in love with the city as a backpacker. To make a living, I worked two jobs, teaching English to first-, second-, and third-graders in the morning, then waiting tables at a restaurant in the evening six days a week.

On this particular day, I’d exhausted my patience trying to get and hold the attention of my students in our tiny classrooms with no windows, so I asked a friend with a tuk-tuk to take me into the countryside for a dose of nature before my restaurant shift began. We traveled 20 minutes out of the city to the end of a dirt road, where wooden huts jutted out over flooded rice paddies and families swam in water the color of coffee with cream. Two double rainbows lit up the sky above us. It was gorgeous, and without a second thought, I got out of the tuk-tuk and jumped in the water.

the author had a health emergency abroad after swimming in the countryside near Siem Reap, shown here.

The author went for a swim in the countryside near Siem Reap, Cambodia. Photo: Stock for you/Shutterstock

Swimming in the flooded rice paddy that day was just the break I needed, but it had unintended consequences. A few weeks later, I developed symptoms of a severe sinus infection, and lab tests showed I had a resistant strain of E. coli in my sinuses. I can’t know for sure if the rice paddy swim was to blame, but it sure seemed like it, especially as the timeline added up. (The Mayo Clinic recommends avoiding water from lakes while swimming, as it can transmit the bacteria).

Fighting off a sinus infection may not seem like a big deal, but for me, it was potentially life threatening. I was born with cystic fibrosis (CF), a genetic disease that causes a defect in a particular cellular protein, leading to an imbalance in how my body processes salt and water in various organs. Patients with CF have much thicker mucus than other people, which causes frequent respiratory infections so severe that some need lung transplants (and many succumb to the disease at a young age). Even though my mutation of CF is mild — I experience sinus infections and stomach issues but have healthy lungs — I’m still legally disabled because of it, and prone to health emergencies.

Up until that point, I’d lived a fairly normal life in spite of my disease, so I’d assumed living in Cambodia wouldn’t pose any serious issues. I was wrong.

Far away from my CF doctors in the US, I took my well-being into my own hands. That meant asking local doctors who had never heard of my disease to culture my mucus and prescribe the appropriate antibiotics, all of which had to be administered intravenously. Eventually, I had to quit my teaching job, as it left me no time to go to the clinic twice a day for infusions. Although the nurses responsible for my care were kind and well-meaning, they didn’t know how to correctly place an IV on the first try, so I left those appointments with bruises up and down my arms.

health emerengcy abroad - writer in hospital in cambodia

The author, receiving treatment in a Cambodian hospital. Photo: Zanny Steffgen

Even after weeks of treatment, the sinus infection raged on. The heavy-duty medication took away my appetite, so I grew weaker and weaker. Soon, I left my restaurant job as well, unable to spend evenings standing and carrying plates. After a few months, I went to a major hospital in Siem Reap for a CT scan, which showed that my sinuses were completely blocked. Desperate for a solution, I ended up flying to Bangkok, Thailand, to see a specialist familiar with my disease. But when he proposed a surgery that would cost more out of pocket than I made in a year, it became clear I had to return home.

In January of 2019, I flew back to the US for sinus surgery, then returned to Cambodia a month later once I’d recovered. But when the infection came back and cultures showed the strain of E. coli had grown even more resistant to antibiotics, the time came to throw in the towel and leave Cambodia for good. It tore me up inside to admit defeat, but looking back on the experience, I’m glad I did.

In many ways, I was lucky. I made it back to the US in time to get the care I needed and bounced back within a few months, with no lasting physical repercussions. As painful as the whole experience was, it taught me a lot about traveling with a health condition, and what to do when you have a health emergency abroad.

Here’s what I learned and what I wish I’d known about dealing with medical issues in another country.

Understand the terms of your travel insurance

close up of laptop and travel insurance forms

The last thing you want during a health emergency abroad is to find out your insurance won’t cover it. Photo: Conejota/Shutterstock

This may seem obvious, but you’ll want to go into your trip (or time living abroad) with a thorough understanding of your travel insurance plan. I hadn’t realized that the expat health insurance plan I’d bought didn’t cover pre-existing conditions. Once I’d submitted multiple bills for sinus infection treatments, the insurance company requested my medical records and later refused to cover anything else that might be related to cystic fibrosis. Suddenly, in the middle of my health crisis, I no longer had insurance.

Make sure whatever plan you choose covers the kinds of activities you’re planning on doing during your travel. Many travel insurance plans have exclusions for “adventure activities,” which may include even hiking or kayaking. It’s also worth finding a plan that covers emergency repatriation in case something goes wrong and you need transportation back to your home country for treatment. Some sports, like scuba diving, have sport-specific insurance, or you can buy general adventure activity insurance.

Get recommendations from your doctor

person getting a travel vaccine - health emergency abroad

Your doctor can recommend any vaccines to get in advance of travel and help recommend other medical professionals in your local country. Photo: SeventyFour/Shutterstock

Whether you have chronic health issues or not, you’ll want to schedule a visit with your doctor before leaving on a trip of any significant length. Beyond getting recommendations for things like vaccinations and medications to have on hand, it may also be worth asking if they know of any doctors in the region where you’re going in case you do have a sudden health emergency abroad.

I was grateful that I’d asked my sinus specialist in the US for a connection in Southeast Asia before departing for Cambodia, as he gave me the name of a doctor in Bangkok he had met at a conference. That doctor ended up giving me the final diagnosis that prompted my trip home.

Have a back-up plan

close up of travel schedule

Don’t jam-pack your travel schedule. Photo: Pamela Lico/Shutterstock

You never want to factor the worst-case scenario into travel plans, but in some cases, like when you’re headed to the other side of the planet or going somewhere particularly dangerous or with poor healthcare, it makes sense to think about it. Since my health emergency in Cambodia, I’ve tried to give myself more flexibility during my travels. That means avoiding non-refundable bookings and paying extra to have a flexible flight ticket, among other things.

Understand how the local pharmacy works

pharmacy in cambodia - health emergency abroad article

Every country has different rules on what can and can’t be sold over the counter. Photo: Giftography/Shutterstock

Drug laws vary wildly in other countries, so I recommend understanding how pharmacies and prescription drugs work in the destination you’re visiting. Some countries limit which or how many prescription drugs you’re allowed to bring into the country. If you rely on a medication on a country’s banned list, which may include some common anti-depressants and narcotics, you’ll want to find a solution with your doctor or book a trip elsewhere.

Similarly, figure out what’s available over the counter where you’re headed. In Cambodia, I could purchase antibiotics without a prescription, which made it easier to get the medication I needed when I had an infection. In some cases, it was cheaper to purchase the IV antibiotic through a local pharmacy and bring it to the clinic, rather than getting it directly through the clinic where I was receiving care.

Look into healthcare in nearby countries

health emergency abroad - thailand hospital

Photo: itsalreadytaken/Shutterstock

You may not have access to high-quality healthcare everywhere you travel. And in certain destinations, entrusting a local clinic with your care may put you at greater risk. If you’re traveling somewhere with a reputation for poor healthcare (as in many developing countries, unfortunately), do some research and see if a nearby country has a more reputable healthcare system. Then, make sure to include that destination in your travel insurance policy just in case. When I was in Cambodia, I ended up traveling to Thailand to see a doctor in a reputable hospital, and had many expat friends who went to Bangkok for major procedures.

Reach out to the nearest embassy

health emergency abroad - foreign embassy

Photo: Stanislav Spurny/Shutterstock

One thing I wish I’d known when I got sick in Cambodia is that US embassies can be a great resource. If you have a health emergency when traveling, you can call the nearest embassy and ask them for help finding medical services. It’ll direct you to a facility that meets your needs, and even get in touch with your friends, family, and employer back at home if need be. They may also be able to set you up with an interpreter if there’s a language barrier that impacts your care.

Know when to go home

woman going home after medical emergency abroad

Sometimes, going home to trusted doctors is the best course of action, even if you may not want to. Photo: Ministocker/Shutterstock

No one wants to give up on a trip and go home earlier than planned, but sometimes, that’s your best option. Moving away from Cambodia was heart-breaking for me, and still hurts to think about years later. But not leaving meant my health could have deteriorated even further, putting my life at risk.

Remember that your health comes first. You can always plan a future trip to a destination, but you can’t ensure a healthy future without taking care of yourself right now.

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