Island Healthcare: Tales from Four Years of Cruising

When you live in the islands long enough, you understand that some things are just handled differently here. Healthcare is one of those things.

We are a healthy family. Even so, as we’ve been cruising, we have had the unplanned joy of medical needs in the Bahamas, Turks and Caicos, Dominican Republic and Grenada. Here’s how they played out:

Bahamas

Turks and Caicos

  • Severe allergic reaction to poisonwood (from a tree in the Bahamas, right before we crossed over to Turks)

Dominican Republic

  • Dental filling
  • Pediatrician Checkup

Grenada

  • Ear infection
  • Dental crown
  • Dental surgery (teeth extraction. Yes, multiple)
  • Kidney stone

Apparently, we like to spread the wealth when it comes to our health. But it has allowed us to gain a real perspective into island healthcare.

Cheap Routine Visits and Unexpected Costs: A Black Bean Tale

Generally speaking, in the Eastern Caribbean, WhatsApp is one of your primary means of communication. It is perfectly normal, sometimes preferred, to message your doctor’s office. Specialists have set appointments, but general practitioners often do walk-ins, which is what we have done with our primary care physician in Grenada. In the States, this would lead to people crowding in as soon as the office opens, and getting angrier and more chaotic as the day goes on. We’ve never waited more than half an hour here to be seen.

Healthcare is generally cheaper in the islands – which is why a lot of cruisers don’t have international health insurance. Paying out of pocket is reasonable – though there are caveats – but understand that there are often two prices. There’s the local rate, and the cruiser/tourist rate.

In Grenada, certain places will accept your boat papers as proof of temporary residence, and they will give you the local rate. Let me tell you – it is not a direct conversion. For example, let’s say that you need a test done, like a CT scan, and the hospital quotes a local price of $1,400 Eastern Caribbean dollars. This is roughly $518 U.S. If you’re not a local, they will simply change the currency – in that the price becomes $1,400 U.S. dollars. That’s CRAZY! But true. When I needed a CT scan done here, I had to call around to two or three places and go with the one that would take our boat papers.

Another consideration in island healthcare is that while the level of care is definitely high, the smaller islands are limited in their technologies, and that can lead to incredible extra costs. Let me give you another example. Back in the States, if a lovely 4-year-old decided to stick something up their nose, you would take them to the local urgent care facility, where they inevitably have the tool that sucks it right out, because it’s a fairly common problem. You may pay up to $200 for the visit. Our lovely Claire decided to do this after we had crossed to the Abacos, in the Bahamas – an extremely remote cluster of islands. We took Claire to two or three local clinics, a transportation feat in and of itself up there, and lo and behold, nobody had the sucker tool.

Claire in her “hospital costume,” as she called it, at the hospital in Nassau, Bahamas, right before they put her under to take the black bean out.

To make a very long story short (read the full post here), in order to get the bean out, I had to fly with Claire from Marsh Harbor to Nassau, take a cab straight to Doctor’s Hospital there, and Claire had to be put under in the operating theater for them to surgically remove it. The bills from the flights, hotel stay, clinics and hospital added up to more than $3,000 U.S. We. Were. Not. Pleased.

My kidney stone, which came to light in Grenada, was another matter that was beyond the scope of island healthcare, due to the size of the stone. Because I needed advanced technologies to break it up and remove it, it was simply an impossibility to get it removed here, so I had to add on the cost of an international flight back to the States to get that sorted. More on that later. Isn’t this fun?

Generally speaking, though, if you have common or routine health issues, you can easily get those sorted in the islands, and at a better price. In the States, you are given the most robust care without question and charged handsomely for it.

This is the clinic on Staniel Cay, Exumas, Bahamas, where I received meds for a stomach ulcer. This is pretty standard for the remote clusters of islands there. They can handle the most basic needs of the small population. Image from gibraltarstanielcay.com.

I visited the clinic on the remote island of Staniel Cay in the Exumas, Bahamas, to get medicine for what I was fairly certain was a stomach ulcer. The clinic looked frozen in time about 20 or 30 years past, and the drug reference manual the nurse used was definitely more than 10 years old. She also searched the recommended drug from the manual on Drugs.com – though let me say that the fact that she had working Internet in the office was pretty impressive. However outdated the whole experience was, it ultimately was just what I needed: She prescribed the right drugs, I took them and got better. $40 U.S. for the visit, another $10 for the drugs.

When Aaron went in for a filling in the Dominican Republic, he got comfortable in the chair, and the dentist immediately got to work. “Whoa!” Aaron said. “Aren’t you going to numb me up first?” She said that if it started to hurt, he should let her know, and then she’d give him some novocaine. He wound up not needing it after all, and the overall cost for the filling was minimal.

Last season in Grenada, I found myself needing to get two teeth extracted, one of them being a wisdom tooth. In the States, many people opt to be knocked out for this. That simply wasn’t an option for me here. The oral surgeon assured me that she would use plenty of novocaine so that I wouldn’t feel anything during the surgery. I would hear it, of course – that’s a sound I’ll never forget.

In the States, before they give you the shots, they swab your gums with lidocaine, so the shots themselves aren’t as painful. No such luck of that here in Grenada, either. So, I felt all 10-12 shots of novocaine into my gums. But again – though it’s not as if I’d love to feel that every day, ultimately, I was fine. The initial visit, x-ray, surgery, post-surgery medications, and follow-up visit, all came out to about $600 U.S.

Sure, if given the option, many people would opt for all painkillers possible, and would happily pay the extra costs. But some, like Aaron and me, may not. And these decisions can significantly impact your overall costs.

Hospital Visits: Guinness for all?

Now let’s talk hospital visits. Doctor’s Hospital in Nassau, Bahamas, operated very similarly to a U.S. hospital, except for the fact that a significant portion of the estimated overall bill was required upfront before any treatment would be administered. Other than that, Claire and I spent the better part of the day in a boring but decently equipped space in the emergency room. We moved up to the surgical wing, and again, the facilities were well outfitted – sheets on the beds, disposable surgical gowns, etc. It may seem silly that I’m making this distinction, but it’s for good reason.

In Grenada, there are two main hospitals in St. George’s, the capital city. There is the general hospital, and St. Augustine’s Medical Services (SAMS). All medical care at the general hospital is free, including for tourists/cruisers, whereas SAMS is private, and medical care is priced accordingly.

St. Augustine’s Medical Services, the private hospital in Grenada. I had my CT scan done here. I took the dinghy to shore, walked to the #2 bus, transferred to the #4 bus, and walked up the road to get here. Not so relaxing of a commute with a kidney stone. Image from NowGrenada.com.

So why go to SAMS? Why not just go to the general hospital? Because absolutely nothing is provided at the general hospital. Patients bring their own pillow and sheets for the beds, their own hand soap for the bathroom, their own toilet paper. Yes, you read that correctly – even if you’re rushed in in an emergency situation, a friend or family member must collect those items for you and bring them in on your behalf.

Side note: There is also an area in the general hospital where you can donate blood. In other countries, when you give blood, you are usually given snacks and juice to help replenish your iron count. At the general hospital in St. George’s, there’s a cooler filled with Guinness. Not a joke. This is what they give you (I’m assuming this is just for adults?) to help replace your iron count after donating.

For more straightforward needs, like getting a cast on a broken arm, or more routine surgeries, the care at the general hospital is just fine, and you can’t beat the price.

To Insure or Not To Insure? A Kidney Stone Tale

Throughout our four years of cruising, we’ve gone back and forth on whether or not we needed health insurance in the States. We knew we were never going to pay for international healthcare – the costs were too high, and the out-of-pocket expenses in the islands were generally minimal. Though we visited family and friends back home once a year, we likely still met the exemption of being out of the country more than 330 days a year, so we wouldn’t be charged the penalty if we didn’t enroll for healthcare.

Some people sign up for travel insurance through the Divers Alert Network (DAN), either on its own or in tandem with other plans, to cover the extreme need for someone to be medevaced out of the islands. (As a side note, sales of all insurance plans through DAN have been suspended, likely due to covid.) We opted against this as well, but we decided to keep a bronze-level plan through the Healthcare Marketplace in the States, in case of emergency.

This wound up being my lifeline for treatment for my kidney stone.

I started having strange stomach pains a year prior, and had seen a doctor a few times to sort it, to no avail. After a near trip to the hospital in early January due to severe pain, I knew I needed answers. I was able to schedule a CT scan at SAMS and a few days later, they sent over the summary of results. Wouldn’t you know it – there was my kidney stone. All 8mm of it.

I needed a urologist. The problem was, this is Grenada, and there is only one urologist on the entire island. Because there is only one urologist on the island, he is extremely busy.

The urologist, mind you, is also one of the general surgeons on island, and also attends international conferences, sometimes sending him off-island two or three weeks at a time. I called the urologist’s office and spoke to the receptionist. Send an email, she said – he is booked solid for the next two months, but we will try to fit you in if there’s a cancellation.

Over the course of the next two months, I did everything I could to get in. My GP called on my behalf, and also had me get the complement of tests done that she knew he would ask for. I emailed my results over. I called regularly. Sometimes someone would answer, sometimes the mailbox was full. At the time, they hadn’t shared the WhatsApp number for the office with me.

This Manchineel tree looks harmless enough, but it packs a bad punch. These are scattered along many of the beaches throughout the Caribbean. Poisonwood is another tree in the same family, more prevalent in the Bahamas. Aaron happens to be very, very allergic, and coming into contact with some of the sap left him headed to the clinic in Turks and Caicos for more powerful meds than we had on board.

Why didn’t I just show up at the office and demand to be seen? Because unlike in the States, where you can often strong-arm your way into getting what you want, it doesn’t work that way here (should it really work that way anywhere?). You wait, like everyone else.

In early March, recognizing that I may never get in, I started looking at other options. I reached out to a urologist in St. Lucia, thinking that it would be easy enough to sail there. He was immediately responsive, but told me he didn’t have the technology on island to treat me. He referred me to a medical tourism outfit in Martinique.

I contacted the company and received a reasonable quote from them, but they informed me that they wouldn’t be able to schedule anything for at least two weeks. You see, it was Carnival, and the whole island shuts down for more than a week to celebrate. If I wanted it sorted quickly, I started to realize that the States may be my only option.

Then I received the Hail Mary of messages – the Grenadian urologist had a cancellation and could see me that afternoon! We dropped everything and made sure I was at the office on time, early even. He was very nice, very knowledgeable, and patiently went through my CT summary with me.

He then said, “Unfortunately, I don’t have the equipment on island to handle a kidney stone of this size. You’ll need to fly to the States for this.” I will say that once I had that appointment, the staff gave me their WhatsApp information, and they’ve been much more responsive ever since.

So after three months of trying here in the islands, I booked flights to Chicago for the following week. The rest, as many of you know, is history – wrapped up in the beginning of a pandemic. When I flew back to Grenada right before the airport closed, I was still recovering from surgery.

Every cruising or traveling family makes their own decision about healthcare insurance. Should we pay monthly for something we will likely never use? It’s a great question. I do know that if we hadn’t, we would be digging out from a $35k hole – U.S. dollars.

Drugs: You need ’em, They Got ’em

The last element to island healthcare that I don’t want to go unmentioned is the availability of drugs. Many people encouraged us to trick out our on-board medical kit as much as possible before departing the States. It was for good reason, given that our first stop after leaving the U.S. was some of the most remote islands we’ve been to.

Some families luck out and work with a doctor that understands what they’re trying to achieve with this lifestyle, and helps them safeguard for it. Inherently, though, you’re asking a doctor to prescribe meds for something that hasn’t happened yet, or may never happen. Antibiotics, for instance, if you find yourself off-grid and somebody gets an infection.

The closest I was able to get to this in the States was finding a doctor at a clinic in Georgia who was willing to see each of us for $150 U.S. per person. She would then prescribe one round of antibiotics for each, for a future occurrence.

We passed and decided to take our chances. In doing so, I learned two things since we’ve been out here:

  1. It turns out drugs, like food, are everywhere. They may not be the same specific brand, but the generic is almost always available.
  2. For better or worse, other countries are nowhere near as strict about dispensing them.

When we were in the Dominican Republic, we became great friends with another family from the States (s/v Freedom, we miss you!). Summer, the mom, is a nurse, so I asked her to help me outfit my medical kit. What would you prescribe for various issues? Which antibiotics for what? What about more robust painkillers? Something for ear infections? Etc.

She wrote them all out for me on a slip of paper, and off I went to the pharmacy in Luperon. I wasn’t sure what they would say – never mind that my high school and college Spanish lessons hadn’t covered much detailed medical jargon – but I had heard that they weren’t as strict as the States.

I slid the paper over to a nice gentleman, who reviewed it for a few minutes. He then pointed to each one.  “¿Cuantos?” “How many?”

Not only did he have them all, but he filled them all for me, and for next to nothing in cost. Now I’m not saying that this is the best policy. Likely, it would be somewhere in the middle, where medical professionals aren’t just handing out drugs, but they’re also not demanding hundreds of dollars in visits just to get to the scripts. I will say that I was so grateful that day, and felt so much more comfortable cruising remotely, knowing that we had what we needed to handle many basic things ourselves.

In many of the countries in the Eastern Caribbean, scripts are still required – but the fee for the doctor’s visit to get them is minimal, and it’s generally a much more efficient process overall.

So there you have it. A small glimpse, or our personal tales, if you will, from four years of nomadic living. We definitely didn’t set out to learn this much about island healthcare. My hope is that we don’t learn more.

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