Canadians should plan for health complications before leaving for vacation: Travel nurse

The family of Barb Johnston — the Manitoba woman who got sick in Cuba and died a day after she returned to Canada on Dec. 29 — is warning travellers to have an emergency plan in place to deal with unexpected health concerns while on vacation.

• Manitoba woman dies of mystery illness after trip to Cuba

Whether it's knowing which clinics are adequate or making a plan to leave the country if need be, there's information Canadians need before they leave for a trip.

Tara Lombardo is the head nurse of Dawson Travel and Immunization Clinic in Guelph, Ont. She spoke to CBC's Trevor Dineen about what Canadians can do before they take off for a sunny destination.

Do people prepare adequately to address health concerns that may arise while they are travelling before they leave?

A lot of people don't even realize that they need travel health insurance when they travel or they just believe that they're young and healthy and nothing's going to happen to them. So, they're not prepared, unfortunately.

I find people are concerned about what beach will be the most beautiful and what hotel will be the most comfortable. But, why don't we spend as much time trying to find out what areas have the best health resources, hospitals and clinics?

I believe in North America we're very privileged and people don't realize when they're travelling to Third World countries how inadequate their health care is and people just assume that when they're travelling there, if they get sick they'll be fine.

There's quite a few good resources out there. There's a few government websites. IAMAT, an international association, [visits] clinics and inspects them frequently to make sure that [they] are actually good; that they're optimal and that they have adequate health care for travellers.

So, those ones you can actually get offline, it's a directory. And the other directory of approved clinics is through the ISTM [International Society for Travel Medicine] as well as the embassy and the International SOS clinics are a good resource, too.

Is there a fee to accessing health care while on vacation?

There's always a fee and usually when you travel internationally, you have to pay upfront the majority of the time. So, we always advise our travellers to make sure that they have a credit card or access to one.

With the IAMAT … you can actually sign up online to be a part of this organization and they send you the directory and they send you a price list of the consultation rates. The problem is the consultation rates are only that. If there's any other care that needs to be done — blood work or say an X-ray or you need to see a specialist — those costs are on top of that.

It could be significant like, up to $100,000 if not more.

Wow. How can people know how well-equipped the health facilities are in the areas that they're going to be travelling to?

So, I always say it's really important to look into your insurance company first thing if anything happens when you're away. When clients come in to see us, we can advise them of some of the clinics that are really good to go to as well. 

What happens if you're travelling in an area and you know that there's not adequate care?

Then you have to find out if you do get sick — and this is the importance of doing everything before you travel — is to find other clinics that are close by that you can [go] to or that you can hop on a plane and travel there to get better health care.

How can travellers get out of the country if they're sick and they require better care?

It's kind of hard in some situations because unless you're medically stable to be transferred, it's really difficult for them to be taken out of a hospital that doesn't' have adequate care.

It's always going back to the insurance company … Some commercial airlines will actually help you leave the country. Of course there's a fee for that and you have to pay for that upfront and then you can always try to claim it with your insurance company. They don't actually do the air ambulance very often unless the patient is really sick.

It sounds like it's a good idea to save up a nest egg before travelling.

Yes, it is.

How important is it to be vocal; to speak up if you don't feel like you're getting the care you need?

You have to always advocate for yourself and for those that are in your care so you do have to speak up.

Even here in Canada, if you don't feel that you're getting [proper] care then you go and report them or you go and speak to somebody else. Say, 'I don't think this care is adequate for my loved one.' The problem is though if you're in a foreign country, you may not speak the language … You can pay an interpreter but sometimes those are hard to find as well.

What should travellers bring to keep themselves safe and in good health on vacation?

We always advise our travellers to make sure that you carry all your medications with you but other things like over the counter medications, too: Advil, Tylenol, Benadryl, antihistamines, Gravol, Imodium. There's quite an extensive list that we recommend to bring with them.

It's good to carry those things with you because sometimes it's not always available in hospitals. Like, in some hospitals they don't even have medications. In Asia, they actually recommend the family members to go to the pharmacy, pick up the drugs that they need, bring them back and then the hospital administers them.

But if they check on the CDC website, it gives a really good packing list.

We always recommend having a cell phone. It's easier to contact somebody from home that way.

Which travel destinations have the best health care?

Around the Caribbean, we always say Barbados, Aruba, Jamaica, Puerto Rico … It's just those ones are a little bit more expensive so if somebody's travelling to [The Dominican Republic] or Cuba then they just have to make sure that they have good insurance so that they can leave the country if they have to.

This interview has been edited and condensed for clarity and length.