Being unlimited in countries with poor medical infrastructure

Type 1 & LADA New T1/LADA
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I met with another T1D mom who had taken their school-age son to Africa, Vietnam, and a few other spots on medical mission trips.

I realized that I would not feel comfortable taking Samson to his relatives in India because of the risk of a stomach bug. In this case, the mom was a nurse and so could place IVs, and they never worried about a situation where his BG dropped too much but he needed insulin – they could always easily administer IV insulin or sugar, and so the worst fear related to diabetes was taken off the table. I realized that if I knew how to get a reliable and hygienic IV set up quickly, I too would be less worried and might be willing to venture overseas with Samson.

I guess I’m wondering how others would feel going to a country with poor medical infrastructure & high odds of infectious disease? What steps would you take to feel comfortable with that trip?

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My son is older, and so I don’t feel the same way about these things. I wouldn’t hesitate to go with him anywhere in the world.

If the training of how to place an IV is what is holding you back, why don’t you learn. It isn’t hard really, and I am sure if you were going to one of these places your physician would prescribe the medical equipment.

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@TiaG, what a great thread!

As you know, we are now planning a 15-month trip, mostly through Europe but also through North Africa, the Middle East and the Balkans, starting next June.

These are questions I have asked myself a lot. My first focus is always the supply chain: how can I get supplies if I need them in a hurry? How can I maintain our supplies in good shape in the climate we will be? I have worked very hard at figuring this out for every place we go.

My second focus is: how can I get medical help if we need it? This is a lot sketchier in some places we are looking at in the Middle East. One thing I did is study how less developed countries deal with cholera (ORT): this seemed to me to be the most critical issue, and it was a relief to figure out a simple rehydrating therapy [not because of the risk of cholera, but because of the risk of dehydration due to food poisoning and diarrhea).

You are making me think hard about administering IVs: maybe we should learn to do it. Although I have heard many stories from nurses on how hard it can be to IV a dehydrated patient whose veins you can’t seem to find.

So far we have spent time in other developed countries and in Central America as well, and have not run into any trouble yet. But my experience is that, to people like us, being unlimited takes a lot of work: a lot of prep work and a lot of experimentation (that sometimes costs quite a bit of money), in order to be unlimited when the time comes.

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If you go this way you will be fine. While it is harder in a dehydrated patient, you won’t be placing it under stress, i.e. if I don’t get this IV in the patient in the next 2 minutes he is going to die. If you understand the technique and go slow you will be good even with a dehydrated patient. I have seen hundreds maybe a couple thousand placements with nurses of all skill levels. As long as your son hasn’t been abusing IV drugs for years I am confident you could get it done, although I think it a bit overkill unless you are 2-3 days away from medical care. Even in pretty isolated places there is access to someone who can place an IV. I would say that if I was running with a toddler with type 1, I see more merit to that since the kids can get to a really bad place so much quicker than our almost adult size teens.

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wish there was some sort of course you could take without going to nursing school, etc… this just seems like a task i would never learn on my own because I’d be too squeamish to do it to myself and would never do it to anyone else for learning purposes.

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I wonder if there is?

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Wilderness survival would teach this, EMT’s get IV training, I received military training in how to do it. The training is out there, and definitely doesn’t require a nursing degree.

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My sister took a phlebotomy course that taught how to draw blood and administer IVs. I think the course was once or twice a week for 6 weeks, and I think it was around $500. It might not be the cheapest way, but you’d probably learn the best tricks of getting a vein in a good phlebotomy class.

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You can take a 1 quarter phlebotomy course at any community college or technical college that trains nurses and CMA’s. I took the course with my wife when she was in nursing school - and I ended up her pin cushion most of the time.

I agree with @Chris - with most kids, other than toddlers, I think it is overkill, but hey… be prepared, I guess.

I have been all around the world, and many of them have “poor medical infrastructure.” My best advice is “be prepared.”

Carry your own supplies, carry an ice pack container for insulin and re-freeze at every opportunity, keep glucose gel/tablets/candy on you, and avoid drinking anything but bottled water. You will always be within a day or two of decent medical care, no matter where you are - and in an emergency, you likely can get there much quicker if you have to. Resupply when you are in larger cities. Go to your travel clinic and get vaccinated well in advance of going. Carry iodine.

@Michel - you should have no worries about Europe and the Balkans. Most of the Middle East as well - I would have other worries as an American there. In North Africa, Tunisia, Egypt (unless you consider this Middle East), and Morrocco are good places to resupply. I can’t speak for other places.

@TiaG - I wouldn’t worry too much about India. Unless your relatives are in remote areas, there are good doctors there - as long as you are prepared.

Again, just my opinion. YMMV.

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“the Balkans” is in Europe. No need to learn how to administer IV as a preparation for a trip through the Balkans. As far as medical infrastructure, competency and access to care are concerned, I’d be more worried if I were from the Balkans and planning a trip to the US then the other way around.

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@kmichel, I agree there are good doctors in India, but the hospitals – even the good ones — are going to be more exposed to superbugs and hygiene issues. I’ve had relatively health family friends/acquaintances go there and die because of poor medical care and a dangerous environment. So I’m not super complacent.

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Re: administering IVs when dehydrated, if you are severely dehydrated it can indeed very hard—when I was hospitalized for severe DKA, I was taken to the ER in an ambulance, and the EMTs tried repeatedly, but could not place an IV (it eventually happened at the ER, but still wasn’t easy, and the arterial blood gas caused damage to the vessel, but arteries are a lot trickier than veins). The most important thing is to not wait that long if really sick—they estimated I had lost about 10 liters of water by then. So if you’re going to be the one doing it, probably better to not wait until it’s dire.

There are a lot of places where I would be incredibly wary of being treated in any medical facility, for the reasons @TiaG describes, that I think are very hard to mitigate if you need that level of care. It used to be that you could get a certain scuba insurance for emergency medical evacuations, and I had it, but now it’s only restricted specifically to diving accidents. Not sure if there’s an equivalent that’s broader—there are some places where by far your best bet for any serious medical situation would be evacuation, but in an emergency that could be extremely expensive. Personally, as a result, there are some places I probably would not travel, which is too bad, but still enough places where I would that I don’t feel particularly limited by that (and I might feel the same even without the diabetes, thanks to the overarching health concern well instilled by my Jewish mom).

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I sure am glad I am an adult with T1 diabetes instead of a child with it or a parent of a child with it. Reading threads like this causes me concern for the seeds of self doubt we’re planting in our children’s minds. Diabetes isn’t this big of a deal. It’s a pain in the butt and requires a fair bit of work, but the notion that we need to train and carry around IV supplies all over the world with us because we’re that frail is really far from the case. I can do absolutely anything any other adult can do. Diabetes causes me no limitations. Zero. I want every kid who reads this to realize that’s what their future can be like.

In the event that you need medical care in a foreign country, it’s available. Manage your blood sugar and be unlimited. Diabetes does not define you and should not be a huge part of your life.

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There is an old Russian saying: У страха глаза велики. Волка бояться, в лес не ходить - «Fear has big eyes. Being afraid of a wolf means not going to the forest»

I don’t let diabetes drive what I can and can’t do. As long as I am prepared ahead of time, I don’t worry about where I go. When my day comes, I can’t prevent it. If it is not my day to die, I won’t. But not everybody is a risk taker like I am :stuck_out_tongue:

Most major insurance companies, such as IMG and Blue Cross also sell “Travel Insurance.” A good many medical insurance plans provided by employers also provide such coverage, so check with your insurance company before buying more.

That said, the State Department has a list of places that sell such insurance.

Many countries require you to have medical insurance that covers you in their country as a condition of entry. I have only ever been asked for proof by Lithuania, though.

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There’s a difference though between insurance that covers you within a country (only as useful as the medical care there), and insurance that will cover your emergency medical evacuation from a country.

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From the State Department link I posted:

Travel Insurance insures your financial investment in your trip. Typically it covers such things as the cost of your lost baggage and cancelled flights, but it may or may not cover costs of medical attention you might need while abroad.
Travel Medical Insurance covers the cost of various levels of overseas medical treatment.
Medical Evacuation Services provides air ambulance, medical evacuation or medical escort service coverage for overseas travelers.

Most travel medical plans cover foreign medical and evacuation.

But I’m not sure why we are talking about living unlimited, but trying to limit ourselves and our children.

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Never mind our government can’t spell and uses improper words…

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I am not 100% sure what you object to, in your comment.

For instance, my son recently spent 2 weeks in Costa Rica, in 90F+ temperatures every day, in places where it takes several hours to find a pharmacy, and where we did not have a car. When my wife stopped at a pharmacy, she found out that they had 1 5x cartridges box of Lantus and no fast-acting insulin. I am really glad that (a) I spent weeks testing how to preserve insulin at reasonable temperature while on the go and (b) we planned carrying lots of insulin supplies, broken up in several batches.

In Canada last Xmas, we also accidentally forgot the bulk of our insulin supplies in a fridge 5 hours from where we were. There again, we were very pleased to have carefully planned the fact that we carried insulin supplies in several batches. Of course, in Canada it would not have been hard to replace the insulin. A Dexcom PDM broke down while in Canada, so we were glad to have two (on top of 2 iphones).

Last summer, in a week-long kayaking trip away from everything, we lost almost everything electronic, and our primary BG meter, despite all of our planning! So we were left, after one week, with one BG meter—if it had failed we would have had to go full Jedi.

So, based on our limited experience traveling with diabetes so far, my personal conclusion is that it does require a lot of careful planning to be able to be unlimited in some places. I don’t see why being ready to do a lot of planning is an issue, if this is what you object to.

Another example: it is impossible to get Dexcom equipment shipped away from your home country. The only way to do that is to get them shipped somewhere in the US (if the US is your home), then have them trans-shipped by a friend over to where you are. Since they have to go through customs, it may take the trans-shipment up to 3 weeks to make it to where you are, in a country in Western Europe with good shipping. So, if you are unaware of these issues, or if you did not plan your supply logistics well enough, you may end up having to deal with less than optimal situations. We are ready to function without a Dexcom, but why should we if we can avoid it?

It can be worse than that. I was raised mostly in Africa and the South Pacific, in many places where the only reliable emergency health supplies were in the naval base where we were living. There were many people living in town hundreds of miles away, with no doctor in proximity. Clinics, when they existed, functioned with minimal hygiene if any. In anything, infrastructure in Africa has degraded since I lived there. Dealing with hard sicknesses for anyone can be difficult. For kids with diabetes, the BG consequences can obviously go south faster. So I don’t think that planning for the worst is bad.

Si vis pacem, pare bellum is the old saying: if you want peace, plan for war. I think this applies well to health: if you want to be healthy, plan for sickness :slight_smile: As a parent, I have fiduciary responsibility for my kids’ health, and I feel compelled to be better prepared for conditions that would apply to them than for those that would apply to me.

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@Sam, sometimes you make statements like this which I’m sure are meant well, but can come off really badly to those of us for whom diabetes has indeed been a huge deal, threatened our lives, and caused harm. I almost died from getting sick while diabetic abroad once. It’s one thing for you to think it’s not a big deal for yourself; it’s another to be judgmental toward others, because you once again are assuming your experience/ease of managing your own diabetes is the same as other people’s.

This kind of attitude is honestly why sometimes I don’t really like the “unlimited” concept. People have limits of all sorts, and that’s fine and important to acknowledge and respect. Diabetes can be part of someone’s limits, and that can be ok and important for that person’s wellbeing. My medical conditions, including my diabetes, absolutely place some limits on me and how I live my life, which doesn’t mean I don’t like a full meaningful life. Part of doing so for me, and I suspect many of the people on here, is finding balances that work best for them. When I’ve ignored some of those limits, it didn’t help me live a richer/fuller life; it was my being in denial and produced harm. So there’s balance to be had in everything for most people, including the concept of unlimited. Judging people on whether they are adequately “unlimited” really doesn’t seem like a community ethos that fosters good community spirit.

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This is the key - plan carefully, and part of planning is being aware of potential issues.

I’ve lived and traveled in occupied lands, in the deserts of Arabia, and the frozen north of Siberia. I’ve had my daughter fall ill in foreign countries. I have lost my insulin pump falling into the rapids on canoe trips.

Sometimes you have to know how to improvise. You cannot possibly plan for every event that might happen. What if you are on the airplane, and the engines fail? Or you are hijacked? Or you stub your toe on a rock? You can’t carry a gun, a hang-glider, and a complete set of possible meds you might need.

I agree with @Sam on this one. I think it is best to teach kids how to improvise in an emergency, and not to worry that their diabetes is limiting them in life. There is nothing a non-diabetic can do, that I, my sister, or my brother can’t do. Heck - my brother didn’t plan to be in an auto accident on his motorcycle in Minneapolis and to lose his leg. But it happened. Now he rides with a titanium leg.

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