You’re travelling overseas when you begin to feel short of breath when walking uphill. Within a day or two you get the same symptoms even if you’re moving slowly on level ground. If you were at home you’d quickly arrange to see a doctor. But what do you when you have an urgent out-of-country medical problem?
Too often, we make the wrong choice. Even if we’re properly insured and in a first world country with excellent healthcare many of us risk taking a flight home before seeking the medical attention we need. That’s because one of our primary impulses when a new illness arises is to get back to the health providers we trust and to the support of our family.
Even if we have access to professional advice we’re still prone to letting emotion trump reason. For example, many years ago my grandfather called me from Florida with the unmistakable symptoms of intestinal bleeding. I told him he needed to go straight to an emergency room; he expressed fears about the local medical system, ignored my advice and got on a plane back to Canada. My brother took him straight to the hospital from the airport, where he was admitted for several days to treat the bleeding.
Fortunately, no permanent harm came to by grandfather. Neither did it to the patient in the scenario at the beginning of this post.
But I have experienced closer calls during the several times I have answered pleas at 35,000 feet for a doctor to attend to a person whose problem began as an out-of-country medical urgency. In two of those cases the patients should never have begun their travel, particularly since they had recognized the seriousness of their pre-flight symptoms from previous episodes of their condition.
Make no mistake: there isn’t much a doctor can do in an inflight emergency. Most of the equipment in the medical kits – stethoscope, blood pressure cuff, ECG machine and blood glucometer – helps to diagnose, not treat. That means that the doctor’s expertise is primarily used to advise the flight captain as to whether or not they must arrange an emergency landing to obtain immediate care for the passenger-patient.
And that also means that regardless of our natural urge to get back home when an out-of-country medical situation arises, we have to understand that when we board a plane we place ourselves at greater distance from medical help. If you have a new illness that’s quickly worsening, think twice before starting to travel home.
But that’s not where the danger of choosing travel over treatment ends.
Many of us know that commercial aircraft have systems to prevent the cabin air from becoming too “thin”. That’s because as the height above sea level increases, the air pressure drops and so does the amount of oxygen available for us to breathe; we could only survive a few minutes with the oxygen available outside planes at normal cruising altitudes
As a result, oxygen masks drop from the cabin ceiling if pressurization fails. Using the masks assures that the crew and passengers have enough oxygen to remain conscious and clear-headed.
What fewer of us realize is that commercial aircraft cabins aren’t pressurized to sea level conditions because that would add significant cost to building and operating the plane. Instead, cabin pressure is maintained at the equivalent of 5,000 – 7,000 feet of elevation (1,500 – 2,100 metres). Unless you live in Denver – the only first world city with that high an altitude – you’re used to an environment with significantly higher oxygen levels than you get in a plane.
That means that if you have a condition that can potentially require oxygen treatment then air travel poses a possible threat. Foremost among these conditions are diseases of the heart and lungs that can make us short of breath with exertion. But blood loss, which reduces our body’s ability to circulate oxygen, also creates risk, which is why I tried to convince my grandfather to avoid air travel in my story above.
Regardless of how inconvenient or worrisome it might seem to seek local care for an out-of-country medical urgency, remember that it’s often less dangerous than starting the trip home. That’s particularly true if you travel by air, which places you at a greater distance from medical help and which confines you in a lower-oxygen environment that can worsen your condition.
Keep those facts in mind to help you maker safe choices when you face an out-of-country medical problem.