RTW Post #6: Free Medical Advice

8/18/13: Bedford, MA, USA  

Katie and I spent a looong time debating whether or not to go on a round the world trip, and perhaps we would’ve taken even longer if not for an unexpected deadline: immunizations.

Depending on which countries you’re traveling to, there are immunizations you should get and must get. Our research showed that based on our route we’d need Hepatitis A & B, Yellow Fever, and potentially a few others. One of these immunizations, Hepatitis B, needs to be administered over the course of 6 months. Excuse me? Did you say 6 months? Yes. Yes I did.

When we learned this news we ran to the calendar. It was fall of 2012. We had a potential RTW schedule in mind but hadn’t solidified anything yet – including even going on the trip! Now, with this looming cutoff in mind, we had no choice but to lock down our plans. There was no time to dilly-dally!

VACCINATIONS.jpg

Our insurance was Kaiser Permanente. Kaiser, as it turns out, has its own travel clinic, which was fantastic news for us. What better way to find out which immunizations we’d need than to speak with someone from the travel clinic? I left a message with them indicating which countries we planned on visiting. When my call was returned I spoke to a very blunt woman who listed off which shots we’d need and the date of our appointments. She told me in her matter-of-fact tone that we’d be getting the following vaccinations:

- Hepatitis A

- Hepatitis B

- Yellow Fever

- Polio

- Meningococcal

- Typhoid (oral vaccine)

She also explained that she entered a prescription for us for a drug called Mefloquine, which is an anti-malaria medication. I asked her how much the shots would cost and she said they would be free!! Now that was something to celebrate! While I danced a little jig on my end of the phone she abruptly ended our call. I guess she wasn’t in a celebratory mood. I had some lingering questions but figured I’d ask them at the travel clinic when we received our first round of shots.

A few weeks later we arrived at the clinic where we were handed off to a nurse named Roger. He quickly went over which vaccines he’d be sticking us with that day before he got the needles out and started plunging. There were no explanations on how long the vaccines lasted, which countries they were effective in, or what possible side effects we should anticipate. As a result, I quickly asked as many questions as I could before our appointment ended.  His brief answers seemed colored with annoyance. Truth is, I expected someone in his line of work to be a bit more forthcoming. After all, nearly all his patients have no idea what foreign diseases they’re up against. I image we all have burning questions about what to expect. Wouldn’t it be easier to have a standard batch of information to rattle off? Sure, it would be boring and tedious for the nurse, but not for the patient!

I’d heard that we may need the Japanese Encephalitis vaccine, so I asked him if we did. “No,” was his response. That was it. No explanation as to why we wouldn’t need it, just one word. No. At this point I was tired of prying information out of him, so I sat back and took my jabs – three in one arm and two in the other.

(Know when to hold ‘em, know when to fold ‘em)

Five shots in one day? We can take it!

During the following months the travel clinic and I played an enchanting game of phone tag and bonded over our mutual irritation. Several things were on my mind. One was Cipro, which is an anti-diarrheal medication. Everyone says it’s a good idea to have it “just in case.” Sounds logical to me. So I called the travel clinic to ask for a prescription and was informed that my primary care physician would have to prescribe it. Fine by me. I wrote my doctor and was told the travel clinic would have to prescribe it. OK then. I called the travel clinic and was told in no uncertain terms that my doctor had to do it. Are you kidding me? I wrote my doctor again, who said again that she wouldn’t prescribe it, then she looped in a woman who works at the travel clinic who also told me I had to call the travel clinic to get the prescription. The worst part was, with the way the Kaiser website worked, I couldn’t write that woman back!!!

This back and forth continued until I told my doctor with unreserved finality what I had learned: the travel clinic can no longer prescribe Cipro, it is illegal, and she can talk to the head of the travel clinic if she has any questions.

I finally got my prescription.

(If at first you don’t succeed, try, try again)

Now, was that so hard?? Yes. For me, it was. Because each of those exchanges involved leaving messages and missing phone calls. And then there was the Mefloquine debacle...

Mefloquine had been a concern since our initial visit. Not only had we read tale after tale of people hating the side effects of the drug, but we’d met people who’d actually taken it and expressed the same kind of hatred. Evidently, Mefloquine delivers depression, anxiety, and extremely vivid and violent dreams, so much so that people stop taking it and risk malaria instead! As it happens, there are several alternative drugs to Mefloquine, none of which were offered to us by the travel clinic. Were they available? How much do they cost? Can we switch over? These questions were left unanswered until one day I finally got a hold of that same lovely lady I’d initially encountered. I can’t remember her name, but for the purpose of irony, I’ll call her Grace.

First, it’ll please you to know that I got a follow up opinion on the Japanese Encephalitis vaccine. I wanted to know if she thought we needed it, and if not, why not? Here’s how that exchange went:

Me: “Will we need the Japanese Encephalitis vaccine?”

Grace: “No.”

Me: “I keep reading that it’s needed in the South East Asian countries we’re visiting.”

Grace: “Will you be in rural areas?”

Me: “Yes, we very likely will.”

Grace: “Will you be working in rice patties?”

Me: “We could be.”

Grace: “Will you be working in rice patties for at least 30 days?”

Me: “Probably not.”

Grace: “Then you don’t need it.”

Apparently, only people with extended exposure to rice patties need this vaccine. The thing that kills me is: They have no idea why we’re traveling to these countries!!!! For all they know we COULD be working for weeks knee-deep in rice patties. These are important questions to ask, but they didn’t, and it irks me that I have to pull teeth to find out the whys and hows of life-threatening illnesses. That’s their job!

Now, back to Mefloquine…

You need that Yellow Fever immunization certificate to get into some countries - they aren't messing around!

From all our research we found the anti-malarial drug of choice to be Malarone (aka Atovaquone). You take it for a shorter period of time and it doesn’t have severe side effects. The one caveat: it’s really expensive.

I asked Grace if Malarone was an option instead of Mefloquine. She explained that it wouldn’t be covered by our insurance and it’s very expensive. “But is it available?” I pushed. Yes, but she couldn’t tell me how expensive it was, only the pharmacy could answer that.

Oh goodie. More phone calls.

In the interest of not boring you, I’ll leave out the rest of our conversation. My impression of her was a bitter woman who was sick of her job, hated answering questions, and wanted to get off the phone as quickly as possible. She butted heads with me at every turn and put up quite a fight against my incessant queries, but I was determined to have all the answers. And I got them. It was a lesson in patience and perseverance. I remained calm and kind to her throughout and, like magic, her mood changed. She transformed from difficult to informative. In the end, she was offering up tips on which bug repellent to use! We’ve since taken her up on that advice.

(Kill ‘em with kindness)

Strangely enough, the pharmacy informed me that Malarone was only $10 for one months worth of pills. Katie and I couldn’t believe it. Seriously, we couldn’t. There had to be a mistake Everyone on the internet was raging over the insane price of this drug. This seemed too good to be true, but we asked for the prescription nonetheless and hoped for the best.

A few days later we cautiously showed up at the pharmacy and inched our way to the front of the line. Our plan was to ditch the meds if the price was outrageous. Our order came out and the woman behind the counter hit some buttons and said “Ten dollars.” Katie and I both grabbed our money, handed it over, and snatched the drugs up before they could change their mind. It was like winning the lottery.

In the end, even though was asked for more, we could only get one months worth of Malarone. I spoke with the head doctor about why he wouldn’t prescribe it. He told me there was a shortage of that medication and that they save it for military personnel and missionaries. He said that even though we were willing to bear the high expense he couldn’t give us any more. “If it was covered by insurance we’d prescribe it to everyone,” he continued.

Interesting… I considered telling him it was covered by insurance, but held back. I didn’t want to get a sudden bill in the mail, know what I mean?

(Let sleeping dogs lie)